os sm 2/97 Summary 97-4 Injuries to caregivers 1994 ___________________________________________ I s s u e s i n L a b o r S t a t i s t i c s ___________________________________________ U.S. Department of Labor Bureau of Labor Statistics Summary 97-4 February 1997 Injuries to Caregivers Working in Patients' Homes The industry that supplies nursing and personal care in patients' homes is adding jobs faster than any other segment of the U.S. economy, having doubled its workforce from a quarter million employees in 1989 to a half million in 1994. And, according to BLS projections, it will probably employ one and one-quarter million workers in the year 2005. That's good news for patients who prefer to receive care in the privacy and comfort of their own homes rather than in an institutional setting. But accelerating demand for home care represents a safety challenge for nurses and other caregivers traveling among and working in patients' homes. This report shows that the home health care industry logs relatively large numbers of lost-worktime injuries resulting from highway accidents, all types of overexertion when assisting patients, and falls inside and outside their homes. Most of the industry's 18,800 injury cases in 1994 involved nursing and home health care aides, and the resulting absence from work due to injury usually lasted 1 to 2 weeks. Overall, the 1994 injury rate in home health care services (474 lost workday cases per 10,000 workers) is about 50 percent higher than the injury rate in hospitals, the institutional setting from which many home-care patients are released, and 70 percent greater than the national rate. (See chart.) The comparatively high rate in the home health care industry reflects in part the relatively large number of highway-related injuries sustained by home care personnel while making house calls. In fact, the industry's rate of highway-related injuries (76 per 10,000 workers) in 1994 ranks fourth behind those in taxicab services (98), school buses (91), and local bus transportation (78). It is well ahead of trucking services (48). In contrast, most industries, including hospitals, report highway injury rates in single digits because they rarely require employee travel during the course of the workday.1 ----------------------------------------------------------------------------------------------------------------------------------- 1 Many home health care workers are assigned to visit two or more clients in a given day, largely explaining why their risk of highway-related injuries is well above average. Highway accidents include work-related injuries of vehicle occupants, primarily drivers, while on public roadways, shoulders, or surrounding areas. Injuries that occur while commuting prior to the start of the workday or after it ends are not counted as work-related injuries. When highway-related injuries are excluded from industry totals, the home health care rate (398 cases per 10,000 workers) still exceeds the corresponding rate in hospitals by nearly 25 percent and the national rate by almost 50 percent, suggesting that there are relatively high injury risks associated with working in and around patients' homes. (See table.) One such risk involves maneuvering patients singlehandedly, often without the use of mechanical lifting devices available in some institutional settings. Many of the patient-handling injuries are classified as "overexertion," which is most often cited nationwide for work-related injuries resulting in lost worktime. The rate for overexertion injuries in home health care services--183 per 10,000 workers--is especially high, in fact, more than double the corresponding national rate and one of the 10 highest rates reported for overexertion injuries among several hundred industries for which BLS published data in 1994. Overexertion injuries occur less frequently in hospitals than in home health care, but the rate in hospitals (144 per 10,000 workers) is nearly double the national rate, a difference that by itself explains why the overall injury rate is higher in hospitals than in private industry as a whole. Among other events leading to work injuries, falling and related incidents such as slipping and stressful bending/climbing result in lost worktime injuries more frequently in home care settings than in hospitals or in most other industries (see table). As is true for overexertion, the rate of falls on the same level in home health care services--71 per 10,000 workers-- is particularly high, more than double the corresponding national rate and among the 10 highest industry rates reported in 1994. Many of the same-level falls of home health care workers are sustained in trying to negotiate ice- and snow-covered streets, driveways, sidewalks, and paths to their patients' homes. Data for this report are from the BLS Survey of Occupational Injuries and Illnesses. A companion BLS program, the Census of Fatal Occupational Injuries, contains information on the number of home health care workers fatally injured, and the circumstances surrounding their deaths. In 1994, for example, the census counted 20 fatal injuries, 12 of them sustained in highway accidents. For more information on injuries in the home health care industry, contact the Bureau of Labor Statistics, Office of Safety, Health and Working Conditions, Room 3180, 2 Massachusetts Avenue, NE, Washington DC 20212. Telephone: (202) 606-6180. Information in this report is available to sensory-impaired individuals upon request. Voice phone: (202) 606-7828; TDD phone: (202) 606-5897; TDD message referral phone: 1-800-326-2577. This material is in the public domain and, with appropriate credit, may be reproduced without permission. The frequency of lost-worktime injuries and how they occur, 1994 Cases per 10,000 full-time workers | 474 500 -| __________________ | | | | |Highway accident | | | | 400 -| |------------------| Highway accident | | | 326 / | | | ___________________ / Highway accident | | Overexertion | |-------------------| 277 / 300 -| | | | | ___________________ / | | | | Overexertion | |-------------------| | | | | | | | | |------------------| | | | Overexertion | 200 -| | | | | |___________________| | |Fall on same level| |-------------------| |Fall on same level | | |------------------| |Fall on same level | |___________________| | | | |-------------------| | | 100 -| | | | | | | | | Other | | Other | | Other | | | | | | | | | | | | | | | 0 |____|__________________|___|___________________|___|___________________|_____________ Home health Private hospitals Total, private industry Source: Bureau of Labor Statistics, U.S. Department of Labor Incidence rates for various ways in which lost worktime injuries occur, 1994 --------------------------------------------------------------------------------------------------------- Cases per 10,000 equivalent full-time workers2 ---------------------------------------------------- Event or exposure1 Home health Private Private industry care services hospitals total --------------------------------------------------------------------------------------------------------- Total................................................ 474 326 277 Total less highway accidents................. 398 323 271 Total less highway accidents and injuries due to overexertion................ 215 179 195 Total less highway accidents, injuries due to overexertion, and falls on same level.. 144 135 162 Selected categories Highway accidents, all types......................... 76 3 6 Collision between vehicles....................... 61 2 5 Overexertion, all types.............................. 183 144 76 Lifting.......................................... 103 78 46 Falls on same level.................................. 71 44 33 Bodily reactions, all types.......................... 52 37 30 Bend, climb, crawl, reach, twist................. 24 16 11 Slip, trip, loss of balance--without fall........ 17 10 9 Falls to a lower level, all types.................... 17 8 14 Fall down stairs or steps........................ 15 4 3 Struck against object................................ 13 15 20 Exposures to caustic, noxious, or allergenic substances.............................. 11 13 14 Struck by object..................................... 10 23 36 Assaults and violent acts by person(s)............... 6 8 3 ------------------------------------------------------------------------------------------------------------------------------ 1 Based on the 1992 BLS Occupational Injury and Illness Classification Structures. 2 Based on days-away-from-work cases which include injuries resulting in missed workdays with or without additional days of restricted work activity. In 1994, the case totals were 18,812 in home health care services, 98,196 in private hospitals, and 2,236,639 in private industry as a whole. NOTE: Data for totals and major categories may include subcategories not shown separately. SOURCE: Bureau of Labor Statistics, U.S. Department of Labor, Survey of Occupational Injuries and Illnesses.