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SE C T I O N T E N - H E A L T H A ND SA F E T Y

Home care involves providing care to clients in their own homes. Not all homes are hazard free, which means there is always the risk of illness or injury. Because Home Care Assistants are exposed to both safe and unsafe working environments, they should be aware of possible hazards. In this section, the Home Care Assistant will learn to identify hazards and take steps to reduce risk, prevent injury and promote safety, which will be of benefit to them and their clients. Precautions to Take for Personal Safety Home Care Assistants are at risk for their personal safety because they usually work alone and are vulneraBle to threats not only on the “;oB-site” But also when traveling to and from the workplace. There are some precautions they might take to reduce their risk:

Scenario Precautions

Safety Precautions to take Before going to a new client:s home.

Scout out the area where the home is located. Travel the safest route and know the locations of safe places such as hospitals

and police detachments. Carry a cell phone or determine the locations of public pay phones. (If pay

phone is in a potentially dangerous area, do not use it.) Carry a list emergency numbers (e.g.. police detachment, paramedics, fire

station, search and rescue) Carry transportation schedules and numbers of taxi companies.

Safety Precautions to take when traveling to a client:s home.

Dress safely (e.g. unrestrictive clothing, non skid shoes, limited jewelry). Stand in the designated waiting area of a subway. Knsure a taLi driver:s picture and identification are displayed. Don:t park in underground parking lots or in out-of-the-way areas. Keep car doors locked and roll up windows. Don:t leave items lying around in the car. Ie.g. medications, purseN. Avoid any parked cars, which have people sitting in them. Stick to well traveled and lit streets. Walk quickly and try to avoid walking through crowds.

Safety Precautions to take when leaving a client:s home.

Place your vehicle keys in your hand before leaving the home. If necessary, have someone walk you to your car. Check the inside and outside of the car before getting in. Lock the car doors as soon as you are in. Don:t use bank machines in the evening or during the night. If you suspect you are being followed head for a police/fire/gas station Don:t hitchhike or pick up hitchhikers, If someBody tries to roB you, don:t resist O instead, shout “FIRE”. If somebody tries to assault you near your vehicle, roll under the vehicle. If somebody tries to force you into a vehicle, fight back (e.g. holler and kick)

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Scenario Precautions

Precautions to take when working in a client:s home.

If client lives in a condominium apartment or other multi-residence complex: Be cautious in elevators (e.g. Stand close to the control panel with your back

against the wall. Get out immediately, if you are feeling uneasy.) o Walk down the middle of the hallway & avoid alcoves. o Keep count of floors when using stairways.

Do not go into homes where it appears that: o your safety may be at risk (e.g. weapons, drugs, alcohol, guard dogs) o people are inebriated o people are abusive o sexual comments/gestures are made

Make a note of where the telephone and exit are located. Be alert for changes in the behavior of people in the home, as they could be

indicative of impending danger. Don:t make promises you can:t keep.

Assessing the Home Environment for Hazards There are occasions when the home environment is not as safe as it should be, especially for a senior client. Home Care Assistants are in a position where they can assess the risk hazard and it is recommended this Be done whenever service starts in a client:s home. The following form will show Home Care Assistants how to conduct a quick and basic assessment of home safety:

Home Safety Assessment

1. Are there sturdy handrails or banisters by all steps and stairs? Yes No 2. Are stairways and hallways clear of clutter and loose objects? Yes No 3. Are all electrical cords placed close to walls and out of pathways? Yes No 4. Are rugs secured around all edges? Yes No 5. Lighting:

a. Is there adequate lighting in all stairways and hallways? Yes No b. Is there a light switch at both the top and bottom of stairs? Yes No c. Is there a light switch by the doorway of each room? Yes No d. Is there a flashlight, light switch or lamp beside the bed? Yes No e. Is there a night light? Yes No 6. Is there a phone by the bed? Yes No 7. Is there a list of emergency phone numbers by the phone for: a. Fire Yes No b. Police Yes No c. Ambulance Yes No

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Home Safety Assessment

8. Bath tub/Shower a. Is there a non-skid surface on the floor of the bathtub or shower? Yes No b. Are there non-skid strips or rubber mats in the shower or bathtub? Yes No c. Are there adequate grab-bars for getting in and out of the shower/bathtub? Yes No 9. Do chairs have armrests which are strong enough for getting in and out of them? Yes No 10. Stools: a. Is a stool needed to reach the higher cupboard? Yes No b. Is the stool sturdy with not more than one step? Yes No 11. Medications: a. Are all medications marked clearly? Yes No b. Are medications named? Yes No c. Are medications dated? Yes No d. Are instructions given as to how medications are to be taken? Yes No e. Are instructions given as to when medications are to be taken? Yes No 12. Are hazardous products labeled and kept in a secure place? Yes No 13. Are outside steps free of cracks, ice and snow? Yes No 14. Is there adequate lighting near walkways & doorways? Yes No Safety Precautions and Minimizing Risks to the Senior C lient Home Care Assistants are not only in a position to conduct an assessment but they also are in a position to educate their clients about safety measures and minimize safety risks. How Home Care Assistants Can Assist Seniors To Minimize Safety Risks

Conduct a Home Safety Assessment and implement safety precautions for any of deficiencies. Since oxygen is highly flammable, precautions need to be taken to ensure that there are no open flames

around it (e.g. burning candle) and that nobody smokes. Do not use products around oxygen that contain petroleum (e.g. petroleum ointment) either for lubrication of

equipment or for labeling. Clean up spills as soon as they occur. Conduct an inventory of hazardous products that are in the home and advise clients how to handle them safely

Iif they don:t already knowN. Always read the labels before using a product. Where necessary, ensure pets are restrained when Home Care Assistant is present. If an animal bites, wash

the wound with soap and water and seek medical attention. Ensure that all weapons are kept out of view and preferably locked up.

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Falls and F ractures Falls are a real threat to seniors because of the increased possibility that bones will be broken. Because people lose fat and muscle mass as they age, their bones do not have the cushion they once had for protection. Compounding the problem are fragility and osteoporosis. (Osteoporosis is an abnormal loss of bony tissue resulting in fragile, porous bones.) It is important for Home Care Assistants to be aware of the reasons why seniors fall and know how to reduce the chances of falling. Causes and Preventions of Falls The causes of falls are called risk factors. The more risk factors individuals are exposed to, the greater their chance of falling becomes. Falls can threaten independence.

The following table outlines the common risk factors of falls for Seniors and suggests preventative measures that can be taken:

Risk Factor Explanation Preventative M easure

Osteoporosis Osteoporosis is a condition wherein the bones become more porous.

Consume sufficient calcium and Vitamin D.

Lack of Physical

Activity

Failure to exercise regularly results in decreased strength, poor muscle tone, loss of bone mass & flexibility.

Exercise regularly. Take safety precautions when conducting daily activities. Wear shoes with rubber soles & grips.

Impaired Vision

Eye conditions such as cataracts & glaucoma can affect sharpness of vision, depth perception, peripheral vision & susceptibility to glare.

Visit the Ophthalmologist (eye specialist) regularly to check for cataracts & glaucoma.

Medications

Anti-depressants, anti-psychotic & sedatives drugs reduce mental alertness, affect balance & gait & cause a drop in blood pressure.

Be familiar with the side effects of medications. Ask a Physician: o if medication is needed o for the lowest dosage o about the need for continued use o limit alcohol intake

Environmental Hazards

Environmental hazards are the cause of 1/3 of falls: o tripping over objects on floor o poor lighting o loose rugs o lack of (or poorly installed)

handrails o furniture that is not sturdy

Outdoors o When the weather is bad, use a walker or cane for

extra stability. o Wear skidded boots with rubber soles for added

traction. o If sidewalks look slippery, walk on the grass for

better traction. o Sprinkle rock salt, kosher salt, or kitty litter on

sidewalks or streets that are slippery. o Be alert for wet, floor surfaces and avoid them

where possible.

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Risk Factor Explanation Preventative M easure

Indoors o Keep rooms free from clutter. o Keep floor surfaces smooth but not slippery. o Avoid walking around in socks or stockings. o Ensure that carpets or area rugs have skid-proof

backings. o Use at least 100 watt bulbs, o Keep a flashlight beside your bed. o Ensure that stairwells are well lit. o Install handrails and grab-bars.

Injuries Home Care Assistants are very susceptible to injuries received in the performance of their duties primarily because of lifting people. Most of these injuries occur in the ligaments, tendons, muscles and joints. How Home Care Assistants Can Protect Themselves f rom Injury

Learn and apply the basics of body mechanics. Request that qualified people demonstrate transfer procedures for individual clients. Ensure that equipment and mobility aids are in good condition. Ensure there is sufficient lighting. Ensure that the environment is kept at a comfortable temperature level. Check the flooring to determine the most suitable means for maneuvering clients. Be aware of and seek input aBout any changes in the client:s condition, which could mean the

transferring techniques being used need to be modified. Apply safe work practices when handling clients and materials. Ensure bathrooms and bedrooms are organized for easy access to client and personal care items.

W ellness Wellness is the concept of practicing all the things which keep one well. It involves maintaining good nutrition, exercise, stress-control, and good personal and familial social relationships. Because of the stresses presented in performing their job, Home Care Assistants are susceptible to physical and mental strain, which can affect their overall wellness.

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Stresses Home Care Assistants F ace

Home Care Assistants face a number of stresses when carrying out the duties of their jobs: e.g.:

They care for frail and ill clients wherein: o there is limited equipment and supplies; o no additional personnel are available to assist; and, o the home may not be clean.

Supervision is not available or is not on site. Clients are demanding because of the number and complexity of their needs. There is a probability for disagreements among family members. It may be difficult to summon assistance. They may have several different clients to see during their working day.

How Home Care Assistants Can Promote Wellness Home Care Assistants can play a role in promoting their own wellness by applying some assistive techniques.

Manage stress by: o relaxing; o talking about problems with a trusted person; o laughing; o seeking assistance; o managing time effectively; o stopping smoking; o limiting alcohol consumption; o being alert for things that cause stress and try to counteract them; and, o delegating, where possible;

Practice relaxation exercises such as deep breathing. Learn to set limits. Keep physically active. Maintain a healthy diet. Get sufficient rest and sleep. Ensure there is a balance between work and family obligations. Take time for “self” every day.

Emergency Preparedness Emergency preparedness involves planning what actions to take in the even of a possible disaster. We all live with the threat of some kind of emergency situation and should know a few basics on what to do when such situations confront us.

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Some of the more common types of emergencies that may develop are:

fire; flood; earthquake; hurricane; tornado; power outages; and, medical emergencies (see Section Eleven).

Since there is usually little warning when an emergency is about to develop, it is very possible that Home Care Assistants will Be at their clients: homes when it strikes. Therefore, it is important that Home Care Assistants know what to do. F ire Things That Can Be Done Before A F ire E rupts

Install smoke detectors on each level of the home. Create an escape plan and practice using it. Practice evacuation procedures by establishing fire drills. Place a ladder or rope on all floors above the first one. Check windows that would be used in an escape to ensure they open easily.

What To Do In The Event Of A House F ire

Get everyone out of the house. Know where exits are (doors and windows) Designate a meeting place outside the house, which will help determine if anyone is missing. Phone the fire department using a cell phone outside or using a neighBor:s phone. Never go back inside for any reason. (Stay at the meeting place and wait for the fire department.) If caught in smoke, crawl along the floor, as the air is less toxic at that level. If clothing catches on fire, “stop, drop and roll”.

F lood A flood is the phenomenon of water levels rising and overflowing onto normally dry land. Floods can suddenly appear or they may be predicted hours/days in advance. Either way, it is important for Home Care Assistants know what to do if there is a flood threat or if a flood occurs, since they may need to provide assistance.

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A flood, which rises and falls quite rapidly with little or no advance warning is called a flash flood. It is usually the result of intense rainfall over a relatively small area. Flash floods can be caused by situations such as a sudden, excessive rainfall, the failure of a dam or the thaw of an ice jam. What to Do When a F lood Warning is Issued

Listen to radio and TV for flood warnings. Move pets, vehicles, and valuables to a secure place. Warn neighbors. Put sandbags or flood boards in place. Ensure there is adequate ventilation. Plug sinks/baths and put a sandbag in the toilet bowl to prevent backflow. Be ready to turn off gas and electricity (get help if needed). Unplug electrical items and move them to a higher level, if possible. Do as much as possible during daylight in case the power fails. Co-operate with local authorities O if they say evacuate, then evacuate.

What to Do During a F lood

Listen to the radio for information. Fill bathtubs, sinks, and plastic bottles with clean water. Bring in outdoor furniture and/or secure any items that could be swept away by floodwaters. Move valuable items to higher floors in your home. If you are advised to evacuate, then leave immediately. Avoid valleys, low-lying areas, and canyons. Don:t attempt to walk through a flowing stream that is aBove ankle level.

Safety Practices to Follow During a F lood

Don't try to walk or drive through floodwater because: o six inches of flowing water can knock a person down; o two feet of water will float a car; o manhole covers may become dislodged; and, o other hidden dangers may be present.

Don:t try to swim through fast flowing water Because you may: o be swept away; or, o be struck by an object in the water.

Don't walk on sea guards (e.g. dams), on riverbanks or cross river bridges because they may: o collapse; o enable large waves to sweep you away; and, o not be able to prevent stones and small rocks from bombarding you.

Don:t consume or come into contact floodwater, as it may Be contaminated with sewage.

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Earthquake An earthquake is the sudden movement of the earth: surface, which can Be caused By:

the wrinkling and folding of the earth:s crust as it coolsC IIf it Breaks during the process, it causes a shock miles below the surface of the earth.)

gas or stem exploding below the surface of the earth; and, volcanoes.

What To Do During An Earthquake

If you are indoors:

o duck or drop down to the floor; o take cover under a sturdy piece of furniture -- hold on to it until the shaking stops (be prepared to

move with it, if necessary); o stay clear of windows, fireplaces, woodstoves, and heavy furniture/appliances that may fall over;

and o stay inside to avoid being injured by falling glass or building parts.

If you are outdoors, get into the open, away from buildings and power lines.

If you are driving, stop if it is safe, but stay inside your car. Stay away from bridges, overpasses and

tunnels. Move your car away from the normal traffic pattern as possible and avoid stopping under trees, light posts, power lines or signs.

If you are in a mountainous area, or near unstable slopes or cliffs, be alert for falling rock and other

debris that could be loosened by the earthquake.

If you are at the beach, move quickly to higher ground or several hundred yards inland. What To Do After an Earthquake

Check for injuries - do not move seriously injured people, unless they are in immediate danger of further injuries.

Perform a safety check for: o fire or fire hazards; o gas leaks: o shut off the main gas valve only if a leak is suspected or identified by the odor of natural gas; o wait for the gas company to turn it back on once the damage is repaired; o damaged electrical wiring - shut off power at the control box;

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o downed or damaged utility lines - stay away from downed lines even if power appears to be off; o fallen objects in closets and cupboards - displaced objects may fall when you open the door. o downed or damaged chimneys - approach chimneys with caution as they may be weakened and

could topple during an aftershock; Check telephones - ensure each phone is on its receiver, as telephones that are off the hook tie up the

telephone network unnecessarily; and, Clean up potentially harmful materials and/or medicines which may have spilled.

Hurricane A hurricane is a tropical storm with winds that have reached a constant speed of 74 miles per hour or more. The center of the storm is called the “eye” of the hurricane. It is usually 20-30 miles wide and may extend over 400 miles. A hurricane can last for 2 weeks or more over open water and can run a path across the entire length of the Eastern Seaboard. The dangers of a storm include:

torrential rains; high winds; and, storm surges.

What To Do If A Hurricane Warning is Issued

Listen for information and instructions on radio. Ensure family members discuss what needs to be done. Make sure everyone knows where to meet and who to call in case you are separated from one another. Determine the needs of family members or neighbors who may need your help. Secure your home - close storm shutters and board up windows. Secure outdoor objects or bring them indoors. Moor boats, if time permits. Gather emergency supplies. Make arrangements for pets, as they are not allowed in emergency shelters. Turn off utilities at the main valves, if instructed to do so. If instructed to evacuate, follow instructions as to where to go and which routes to take. Ensure vehicle is fueled and you have emergency supplies are with you. Leave immediately to avoid being marooned by flooded roads and fallen trees, especially if you live

in a low-lying area, a beach front, or a mobile home. Stay away from coastal areas, river banks, and streams. If you have time, tell others where you are going.

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If you are not required to evacuate:

Stay indoors during the hurricane and away from windows; Go to the basement or storm cellar. If there is no basement: o Go to an interior room on the lower level such as closets and interior hallways. o In a high-rise building, go to a small, interior room or hallway on the lowest floor possible - be

sure not to be directly under heavy appliances on an upper floor. Do not be fooled if there is a lull in the storm - it most likely means you are in the eye of the storm, in

which case winds will pick up again shortly. Avoid using the phone except for serious emergencies - local authorities need first priority on

telephone lines.

Tornado A tornado is a violently rotating column of air, which extends from a thunderstorm to the ground. The most powerful tornadoes are capable of producing speeds greater than 250 miles per hour. Damage in the path of a tornado can spread more than one mile wide and 50 miles long. They are formed by winds changing direction during a storm. Before thunderstorms, for example, it's common for winds to change direction and speed, which creates a spinning effect in the lower atmosphere. As warm air rises within the thunderstorm, updrafts tilt and begin to rotate vertically, as they are met by colder streams of air. What to Do During a Tornado If at home:

If you have a tornado safe room or engineered shelter go there immediately. Go at once to a windowless, interior room; storm cellar; basement; or lowest level of the building. If there is no basement, go to an inner hallway or a smaller inner room without windows, such as a

bathroom or closet. Get away from the windows. Get under a piece of sturdy furniture such as a workbench or heavy table or desk and hold on to it. Use arms to protect head and neck. If in a mobile home, get out and find shelter elsewhere.

If at a community facility

Go to the area designated area, if there is one. Avoid places with wide-span roofs such as auditoriums, cafeterias, large hallways, or shopping

malls. Get under a piece of sturdy furniture such as a workbench or heavy table or desk and hold on to it.

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Use arms to protect head and neck.

If outdoors:

If possible, get inside a building. If shelter is not available or there is no time to get indoors, lie in a ditch or low-lying area or crouch

near a strong building. Be aware of the potential for flooding. Use arms to protect head and neck.

If in a car:

Never try to out-drive a tornado in a car or truck. Get out of the car immediately and take shelter in a nearby building. If there is no time to get indoors, get out of the car and lie in a ditch or low-lying area away from the

vehicle. Be aware of the potential for flooding.

Power Outages If there is an unexpected disruption in electrical power, for whatever reason, there are some things Home Care Assistants need to know:

Food Safety

Food in the refrigerator or freezer will remain safe for consumption if power is out for less than 2 hours. If less than two hours: keep the refrigerator and freezer doors closed to retain colder temperature.

If more than two hours: o A freezer that is half full will hold food safely for up to 24 hours o A full freezer will hold flood safety for up to 48 hours. . o Place items for refrigerator in a cooler surrounded by ice. o check temperature of food prior to cooking - if it is 40 degrees F. or more, discard.

Safe Drinking Water

Do not use contaminated water to wash dishes, brush teeth, wash & prepare food, wash hands, make ice, or make baby formula.

Boil water (length depends on what state or health departments consider appropriate for the area).

To kill bacteria, treat water with: o chlorine tablets (follow directions) o iodine tablets (follow directions) o household chlorine bleach (1/8 tsp./gallon if water is clear; ¼ tsp/gallon if water is

cloudy) Rinse containers with water treated with bleach before using them.

Note: While boiling water will kill parasitic organisms, chlorine, iodine and bleach won:t kill them. (However, chlorine, iodine and bleach will kill bacteria.)

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Power Line Hazards & Vehicles

If a downed power line touches a vehicle, remain in the vehicle and: warn people not to touch the vehicle phone or ask someone to phone 911 or the utility company

If the vehicle catches on fire, open the door and: jump free of the vehicle so the body clears the vehicle before touching the ground; walk in a shuffling manner to at least 50 feet from the vehicle.

Note: Do not step out of the vehicle onto the ground!

Extreme Heat

Be alert for heat stroke, heat exhaustion, heat cramps and fainting. To avoid heat stress: Drink a glass of fluid every 15 to 20 minutes and at least one gallon each day. Avoid alcohol and caffeine, as they cause dehydration.. Wear light-colored, loose-fitting clothing. When indoors without air conditioning, open windows if outdoor air quality permits

and use fans. Take frequent cool showers or baths. If dizziness or overheating occurs: o seek a cool place o sit or lie down o drink water o wash head and face

Work during cooler hours or distribute the workload evenly throughout the day. (See Section Eleven for First Aid Procedures)

Extreme Cold

Hypothermia happens when a person:s core Body temperature drops at least 2 degrees Fahrenheit below the normal body temperature of 98.6 degrees Fahrenheit.

Ways to prevent hypothermia o Ensure adequate food, clothing, shelter, and sources of heat o Use electric blankets & heating pads o Wear layers of clothing, which help to keep in body heat. o Move around because physical activity raises body temperature.

Electrocution Electrocution is the passage of a low frequency electric current through the body, often resulting in death. The most common causes of electrocution are overhead power lines. Utility lines are not usually insulated, which means the lines are bare. People usually die when they come in contact with a live utility wire because they contact the earth and the wire at the same time. This creates a pathway for the electricity to travel through. (When birds sit on a live wire, they are not electrocuted because they are only in contact with the line.) Electrocution can also occur in the home. Home Care Assistants can help prevent shock or electrocution by taking/following certain safety precautions:

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Electrical cords

Ensure cords are in good condition. Don:t place them under carpets or allow furniture to rest on them.

Extension cords Use only on a temporary basis. Ensure cords are not overloaded.

Plugs

Ensure plugs fit the electric outlet. Don:t remove the third prong to make it fit into a 2-prong outlet. Don:t force a plug into an outlet if it doesngt fit. Avoid overloading outlets with too many appliances.

Electrical Outlets Check for outlets that have loose-fitting plugs, as they can overheat and cause

fire. Replace any broken or missing wall plates.

Light Bulbs

Ensure light bulbs are the correct wattage for the fixture. Replace bulbs that have higher wattage than recommended. Ensure bulbs are screwed in securely, as loose bulbs may overheat.

Appliances

Have the appliance repaired or replaced if it: o blows a fuse; o trips a circuit breaker; or, o gives a shock.

Computers &

Entertainment Items

Ensure equipment is in good condition and working properly. Watch for damaged wiring, plugs, and connectors. Use a surge protector.

Breakers & Fuses Ensure they are proper for the circuit. When replacing the fuse, replace it with one that is the same size.

Water

Don't leave plugged-in appliances where they might come in contact with water. (Never reach into water to retrieve an appliance that has fallen in, even if it is unplugged. Instead, turn off the power source at the panel board and then unplug the appliance. )

If an appliance gets wet, have it checked before using it.

Space Heaters

Keep space heaters at least 3 ft. away from any combustible material. Turn heaters off and unplug them when not in use.

Halogen Floor Lamps

Don:t place halogen floor lamps where they can come in contact with materials that are combustible.

Don:t leave the lamp on when the room is vacant.

Lightning

During an electrical storm: o don:t use electrical appliances, including telephones IeLcept for

emergencies). o don:t take a Bath or shower. o use surge protectors on electronic devices.

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Outdoor Equipment

Don:t use electric equipment: o when the ground is wet o when it is raining o on we grass; or, o in wet conditions

Check equipment for frayed cords, broken plugs & damaged housings. Use extension cords, which are designed for outdoor use. Unplug all portable tools when not in use. Watch out for power lines when using metal ladders.

Summary Although, a number of medical and non medical people can be involved in the delivery of home care services, Home Care Assistants are the ones who spend the greatest amount of time with clients either in their homes or on outings. Therefore, they will most likely be the person on duty to provide assistance and direction. In order to promote a safer home and working environment, certain skills are essential to reduce risks, to prevent injuries and to promote worker/client health and safety. Skills can be gained by obtaining knowledge on how to assess the home environment for health and safety; by knowing how to prevent unsafe conditions from developing; by being able to identify potential danger threats; and, by knowing what to do if an unsafe or unhealthy condition surfaces. It is important that Home Care Assistants gain this knowledge prior to commencing work because disasters often strike without warning and actions must be taken immediately. They will not usually have the opportunity to research emergency preparedness once an emergency situation strikes.