PURPOSE: This National Institute for Occupational Safety and Health–funded R01 aimed to identify (1) the slip, trip, and fall (STF) hazards encountered by and (2) hazard mitigation strategies used by home health care workers (HHWs) in client homes.

BACKGROUND: HHWs are vulnerable to injuries because of hazard exposure. Rates for STF-related injuries are about 30%–60% higher in home care compared with private industry. Home health care is particularly challenging because of the complexity of work activities and settings and the fact that HHWs have limited control of the environment, limited access to colleagues for problem solving, and challenges acquiring equipment for task modification. Improved understanding of the hazards associated with STF and the ways HHWs respond to these hazards are critical for development of effective risk reduction interventions.

DESIGN: The study used a mixed-methods participatory design process (interdisciplinary, user centered, iterative) to identify the design of a typical client home, STF hazards, and HHWs’ responses to STF hazards.

PARTICIPANTS: Sixty-eight home health occupational therapists, physical therapists, nurses, managers, health and safety educators, and home health aides participated.

METHOD: Focus group and structured individual interviews were the primary method of data collection. Participants also completed the Modified Home Healthcare Worker Questionnaire, which included questions about commonly encountered hazards. They participated in a structured discussion and completed an activity in which they created drawings of rooms and hazards, prioritized hazards, came to consensus about priority hazards, and discussed responses when encountering these hazards.

ANALYSIS: Quantitative data were analyzed descriptively (SPSS version 21). Interviews were recorded, transcribed, verified, and analyzed using the method of constant comparison. Drawings were analyzed by participants and investigators, using an iterative method of depicting hazards and a systematic method of hazard prioritization. All sources of data were triangulated to establish credibility. The final coding scheme and thematic layers were established in multiple consensus meetings. Results were verified through member checking and review of available literature, injury/illness data from the Bureau of Labor Statistics, and expert review.

RESULTS: STF hazards included, for example, clutter, excess furniture, tight spaces, cords/tubing, and slippery floors. Hazard mitigation strategies included optimal, mixed, and suboptimal responses (e.g., rain boots with gripper soles worn while bathing a client—optimal; using an office chair to transfer a client—suboptimal). Less-than-optimal solutions (mixed; suboptimal) to STF hazards were reported by 68.5% of participants.

DISCUSSION: HHWs’ decisions about hazard mitigation were influenced by their knowledge of the hazard, perceptions of risk, and the need to provide care for clients, which superseded personal health and safety. Insufficient training and resources present important barriers to HHWs trying to remain safe at work. In the absence of resources, HHWs make do with hazardous situations, not always in ways that protect them from harm. Occupational therapists can play an important role in preventing these injuries and reducing risk.

IMPACT STATEMENT: HHWs face substantial STF hazards in client homes. Because synergies exist between worker and client safety, it is critical to identify and design trainings and policies for optimal hazard management. Occupational therapists can provide expertise in home modification and assist HHWs in identifying and responding to STF hazards.