Safety Risks and Preventive Measures for Home Health Care Workers

The nonfatal occupational injury and illness rate among home health care workers is almost two and a half times the rate for all private and public sector workers, according to a 2011 study by the U.S. Department of Labor’s Bureau of Labor Statistics.

Home health care workers include personal aides, nursing assistants and home health nurses. Their job is to provide hands-on, long-term care to patients in their homes. If they understand the safety risks and follow preventive measures, they can help ensure their safety on the job.

Risk: Unsafe conditions

Home health care workers can be exposed to unsafe conditions, such as homes without water or with extreme temperatures, unsanitary conditions, rodents and hostile pets.

Preventive measures:

• Understand which conditions are acceptable for a work environment.
• Know when to remove yourself from a situation.
• Talk to your supervisor about unsafe conditions in clients’ homes.
• Follow your employer’s procedures for reporting unsafe conditions.

Risk: Bloodborne pathogens

Hepatitis B, Hepatitis C and HIV are just some of the more common bloodborne pathogens home health workers can be exposed to. Exposure may occur through needles, sharp injuries, mucus membranes and skin exposures. 

Preventive measures:

• Learn your employer’s exposure control plan.
• Wear gloves, goggles and other appropriate personal protective equipment at all times.
• Follow protocols when handling blood or other body fluids to prevent direct exposure.
• Completely seal containers, following proper medical procedures.

Risk: Workplace violence

Workplace violence includes verbal abuse, threats, physical abuse and homicide. Employers should maintain a zero-tolerance policy for violence.

Preventive measures:

• Immediately report violence to your employer.
• Know how to identify a potentially dangerous situation.
• Ask your employer for training on how to manage hostile and violent situations.
• Remove yourself from the home if you feel uncomfortable at any time.

Risk: Lifting and moving clients

Moving bedridden patients can cause musculoskeletal disorders, such as low-back pain and rotator cuff injuries. These can be caused by excessive force to the back when lifting a client, the repetition of the movement and lifting in an awkward position.  

Preventive measures:

The best solution is to minimize or eliminate manual lifting of patients when possible. If that is not possible, consider these factors:

• The level of assistance the patient needs
• The patient’s size and weight
• The patient’s ability to understand and cooperate
• The patient’s medical conditions

Risk: Motor vehicle accidents

Home health care workers travel to and from patient homes every day. In fact, driving can be the most frequent task they perform, increasing their risk of traffic accidents.

Preventive measures:

• Stay alert and drive defensively.
• Make sure your vehicle is regularly maintained and serviced.
• Adjust accordingly for weather and traffic conditions.

The more home health care workers are prepared to protect themselves against these hazards, the more productive and safe the environment will be for them and their clients.

Workers’ comp: What’s on your mind?

Post-accident cost control tops the list of employers’ workers’ compensation concerns, according to a 2013 study released by ZyWave. Ironically, accident prevention ranked a close second, indicating some employers are putting the proverbial cart before the horse.

Also weighing heavily on employers’ minds are obesity and diabetes, as well as workplace violence.

If you share these concerns, you’ll love this week’s list of best workers’ comp practices.

Accident prevention
The best way to control claims costs is to prevent accidents from happening in the first place. Texas Mutual recommends that every employer create a documented safety program and, just as importantly, enforce the program.

If you don’t have a safety program and you’re not sure where to start, visit texasmutualsafetyfirst.com for three simple steps to preventing workplace accidents.

Employers can take advantage of other free resources at worksafetexas.com, safehandtexas.org, the Texas Department of Insurance, and the Occupational Safety and Health Administration.

Post-accident cost control
What do you do when an employee gets injured on the job? File the claim and let your insurance company handle it? If so, you are missing valuable opportunities to control your claims costs and, ultimately, your premium.

A return-to-work program is a proactive way for employers to manage their claims. You should customize your program to meet your needs, but it should include these core steps.

Before an accident:

1. Put your return-to-work program in writing.
2. Assess job tasks, documenting the physical demands.
3. Identify modified duty injured employees can do while they recover.

After an accident:

1. Communicate regularly with the injured worker, the doctor and the insurance company.
2. Make a bona fide offer of employment when you have identified a modified duty assignment. See DWC Rule 129.6 for more information on bona fide offers of employment.

Texas Mutual and the Texas Department of Insurance offer free resources to help employers launch a return-to-work program or improve an existing program.

Obesity
Unhealthy habits can affect work performance, motivation, quality of life and self-worth. From an employer’s perspective, an unhealthy worker can contribute to increased health care costs and workers’ compensation claims related to health problems.

A Duke University Medical Center study found that obese workers filed twice as many workers’ compensation claims, had seven times higher medical costs from those claims, and lost 13 times more days of work from on-the-job injuries or illnesses than non-obese workers. Ultimately, obesity costs employers $73 billion per year.

An employee wellness program can help reduce those costs and promote a happier, more productive workforce.

Workplace violence
Do your employee work late hours, exchange money with the public or guard valuable items? If so, they may be at risk of workplace violence.

Workplace violence is the second-leading cause of on-the-job fatalities, according to the National Institute of Occupational Safety and Health (NIOSH).

A report by the U.S. Department of Health and Human Services and NIOSH found that each week in the United States, there are nearly 20 homicides and 18,000 assaults in the workplace. Preparation and planning can help minimize the number of employees involved in a violent workplace incident.

Electrical Safety: It’s Not Just for the Pros

Look around your workplace. If you’re on a construction site, you probably see power saws, drills and other electrical tools. If you’re in an office, you’re surrounded by computers, telephones and coffee pots.

The point is that regardless of your industry, you use equipment that runs on electricity. If you do not have safety procedures in place, that equipment can cause serious workplace injuries, up to and including death. The most common emergencies associated with electricity are shocks, burns, fires and explosions.

Electricians are trained to avoid the risks associated with working around electricity. The rest of us can follow a few simple tips to stay safe on the job:

Inspect and maintain equipment

Damaged or malfunctioning equipment increase your employees’ risk of getting injured. Before using power tools, cords and other equipment, make sure it is in good condition:

• Check tools for broken casings, as well as loose screws, nuts, bolts and moveable parts.
• Inspect power cords for exposed wires, cracked casing, and bent or broken prongs.
• Make sure receptacle outlets are not cracked or broken, and have cover plates in place.
• Ensure breaker panels have covers, and breakers are labeled.
• Keep equipment clean and lubricated.

Practice safe behaviors

The safest way to do the job is not always the easiest way or the quickest way. Unfortunately, shortcuts get people injured. Every employee should understand that the company expects them to practice safe behaviors:

• Understand which tasks require insulated gloves, metal-free shoes, hard hats rated for electricity and other personal protective equipment, and wear that equipment every time you do those tasks.
• Stop using damaged and malfunctioning equipment immediately, and report it to a supervisor. Tag this equipment as “Damaged—Do Not Use” so others don’t get injured.
• Remember that electricity flows easily through metal and water. Avoid using electrical tools in wet conditions. Remove metal jewelry, and do not use metal ladders or tools near power lines or other sources of electricity.
• Follow the company’s lockout/tagout procedures. If you do not know the procedures, ask your supervisor.
• Keep at least 10 feet between you and overhead power lines, per federal regulations. Additional minimum clearance is required for power lines carrying over 50,000 volts.
• Respect high-voltage warning signs and barricades.

Be prepared

Prompt, calm actions save lives in emergencies. Electrical shocks and burns are no exception. Everyone should know how to respond if a co-worker is in danger:

• Create an emergency preparedness plan that includes procedures for reporting emergencies, getting medical attention for victims, evacuating the building and safely maintaining critical operations.
• Ask for volunteer first responders (VFRs). VFRs should be trained in emergency response procedures, including CPR and other basic first aid.
• Clearly mark the locations of escape routes, first aid kits, emergency defibrillators and fire extinguishers. Before you use a fire extinguisher, check the label to ensure it is safe to use on electrical fires.
• Stay calm if you call 9-1-1. Make sure you know the address where the emergency happened. Let the operator guide the conversation, and respond clearly and calmly. If possible, stay with the victim while you are on the phone.

The most serious consequence of any workplace accident is the human cost of pain and suffering. Businesses also have to consider the impact accidents have on productivity and employee morale. Working together, employers and their employees can create an environment in which workplace accidents are not an inevitable consequence of doing business.

Texas Mutual Board Approves $175-Million Policyholder Dividend Distribution

The policyholder owners of Texas Mutual Insurance Company will share a $175-million dividend distribution this year, the company’s board of directors announced after a unanimous vote on May 7, 2013.

This is the 15th consecutive year that the board has voted to distribute policyholder dividends, bringing the total to almost $1.4 billion. It has paid the majority of that total – $1 billion – since 2007.

Dividends reward loyal policyholders who share Texas Mutual’s commitment to preventing workplace accidents and helping injured workers get back on the job.

Texas Mutual plans to begin distributing dividends among qualifying policyholders according to its normal schedule.

“Texas Mutual is a policyholder-owned company,” Bob Barnes, chairman of Texas Mutual’s board, said. “Our singular focus is on delivering benefits to our employer owners and taking care of their injured workers. Dividends are part of our long-term strategy for helping Texas employers control their workers’ compensation costs.”

Texas Mutual President and CEO Richard Gergasko said the company’s dividend track record reflects its permanent commitment to Texas businesses.

“Texas Mutual is more than a workers’ compensation provider,” Gergasko said. “We are a business partner to Texas employers, and we understand the importance of these dividends to our policyholders. This money goes back into the Texas economy and help employers build their businesses for the future.”

Gergasko noted that Texas Mutual cannot guarantee future dividends, and the 2013 dividend plan requires Texas Department of Insurance approval.

3 Basic Steps to Ladder Safety

Everyone knows how to use a ladder. Of all the hazards your employees face on the job, ladders are among the least of their concerns, right?

Not necessarily. About 187,000 Americans are injured annually on ladders. Every year, more workers are injured in falls from ladders than from any other elevated surface.

If you train your employees to follow these three basic steps, you can help ensure they arrive back at ground level safely.

Step 1. Inspect the ladder:

• Ladder is rated Type I (industrial use) or Type II (commercial use), not Type III (household use). The ladder’s rating should be listed on a color-coded label on the side rail.
• Rails are strong and undamaged
• Rungs and steps are solid, undamaged and free of oil, grease and dirt
• Fittings are tight
• Spreaders and other locking devices are in place
• Non-skid safety feet are in place
• No structural defects
• All support braces are intact

Step 2. Set up the ladder properly:

• Choose a clean, slip-free, level surface
• Use the 4-to-1 rule, placing the ladder base 1/4 the height of the ladder from the wall when using an extension ladder. For example, if your ladder is 8 feet tall, the base should be 2 feet from the wall.
• A straight or extension ladder should extend 3 feet beyond the level it is being used to reach when stepping off. For example, if you are using a ladder to access a roof, your ladder should extend three feet higher than the roof.
• Secure or tie the extension ladder to prevent slippage. Have a second person hold the bottom of the ladder whenever possible.

Step 3. Use the ladder safely:

• Face the ladder
• Use both hands
• Wipe dirt and grease from your hands and shoes
• Never allow more than one person on a ladder
• Use carriers and tool belts to carry objects up a ladder
• Do not lean out from the ladder
• Never shift the ladder while your weight is on it
• See manufacturer label for maximum rung height to work safely from
• If you are afraid of heights, don’t climb a ladder

Texas Mutual policyholders can get free materials on ladder safety in the safety resource center at texasmutual.com. Anyone can visit the Occupational Safety and Health Administration, laddersafety.org and the National Safety Commission for free resources.

The A,B,C’s of OSHA’s New Hazard Communication Standard

Do you have any acetone lying around your workplace? Unless you’re in the business of cleaning brake pads, probably not. But what about paint, glue or cleaning products?

The point is that most businesses use potentially hazardous chemicals in some form or fashion. The Occupational Safety and Health Administration (OSHA) requires manufacturers to properly label those chemicals. It also requires employers to train employees on how to safely handle chemicals.

In March 2012, OSHA introduced changes to its Hazard Communication Standard (HCS). The new standard, called the Globally Harmonized System of Classification and Labeling of Chemicals (GHS), is designed to improve the quality, consistency and clarity of hazard information that workers receive.

What changed?
The GHS includes three significant changes employers and employees need to know about:

• Hazard classification. OSHA changed the definition of hazard to provide specific criteria for classification of health and physical hazards, as well as classification of mixtures. These specific criteria will help ensure that evaluations of hazardous effects are consistent across manufacturers, and that labels and safety data sheets are more accurate.
• Labels. Chemical manufacturers and importers will be required to provide a label that includes a harmonized signal word, pictogram and hazard statement for each hazard class and category. Precautionary statements must also be provided.
• Safety Data Sheets. Referred to as Material Safety Data Sheets under the old system, Safety Data Sheets will now have a specified 16-section format.

What didn’t change?
The GHS is a modification to the HCS. The parts of the HCS that did not relate to the GHS, such as the basic framework, scope and exemptions, remain largely unchanged. There have been some modifications to terminology, though. For example, the term “hazard determination” was changed to “hazard classification,” and “material safety data sheet” was changed to “safety data sheet.”

What does it meant to you?
OSHA requires employers to train their employees on the GHS by December 1, 2013. Training must include information on the new label elements and the safety data sheets. To help you comply with the requirements, OSHA published a GHS page on its website.

Click here for other key dates regarding GHS. OSHA also offers more information on labels/pictograms and Safety Data Sheets.

Should Employers Pay Medical Bills Out of Pocket?

Some employers may be paying for seemingly minor medical care out of pocket, without involving their workers’ comp carrier. These employer/provider small-claim arrangements typically work like this.

The employer signs a formal, binding contract making them directly responsible for payment of services rendered. The employer also submits the insurance carrier’s contact information to the health care provider. The provider then sends all bills directly to the employer, as well as a “for information only” copy to the insurance carrier.

While the law allows small-claim arrangements, they are not always in employers’ best interests.

Employers may be paying for non-compensable claims
Insurance carriers investigate accidents to determine whether claims are compensable under the Texas Labor Code. By paying for claims out of pocket, employers do not give carriers the opportunity to conduct investigations. Consequently, employers may be paying for non-compensable claims. They may also be paying for co-existing conditions the carrier would have uncovered during an accident investigation.

The law allows health care providers to bill employers their usual and customary fees. Insurance carriers, conversely, reimburse providers according to the Texas Department of Insurance, Division of Workers’ Compensation medical fee guidelines, which are typically much lower than usual and customary fees.

Furthermore, many insurance carriers offer workers’ compensation health care networks. Carriers negotiate rates with network providers. Again, those rates are generally lower than usual and customary charges.

Minor injuries can get worse
Assume an employee cuts his finger. After the accident, he goes to the doctor, gets five stitches and returns to work the next day.

What if a week later, the employee gets a secondary infection that requires a hospital stay?

The point is that minor injuries can get worse, and their associated costs can skyrocket. If the policyholder reports the accident to the carrier, the carrier will manage the claim and act on the policyholder’s behalf.

Employees could be denied care
If an employer owes a provider for a previous claim, the provider may turn away the employer’s injured workers until the employer pays the bill.

Policyholders assume an administrative burden
Under the Medicare, Medicaid and State Children’s Health Insurance Program (SCHIP) Extension Act (MMSEA), carriers that provide liability, no-fault and workers’ compensation insurance, as well as employers who pay their own claims, must identify the Medicare beneficiary status of claimants and report claim data quarterly to the Centers for Medicare & Medicaid Services.

Insurance carriers comply with MMSEA requirements on employers’ behalves. Employers who pay claims out of pocket are responsible for complying with the requirements. This added administrative burden leaves less time for the business of running a business.

More information

For more information on this topic, visit texasmutual.com/news/smallclaims.shtm, and consult these sources:

• Health care provider billing procedures. Title 28 Texas Administrative Code, Chapter 133.20
• MMSEA. 42 United States Code, Section 1395y(b)(7) and (8)
• Workers’ comp benefits. Texas Labor Code, Chapter 408.00