Home Caregiver Safety when Assisting with Bathing and Toileting

Home care workers who assist with personal care have much higher rates of musculoskeletal disorders (MSDs) of the back and shoulder than the general working population. This thesis identifies and describes activities that are likely to contribute substantially to the development of MSDs, then identifies and evaluates ways to reduce risk. Physically demanding activities and aspects of the home care context that contribute to MSD risk are identified through a literature review and through focus groups with home care providers, leading to a focus on toileting and bathing. An observational study was used to analyze providers’ postures and related lower back loads while assisting with these activities in a simulated home care scenario. During toileting, exposures to MSD risk factors were highest when managing clothing, providing posterior perineal care and during transfers. One third of providers’ exposure to severely flexed trunk postures, which are powerful predictors of lower back MSD risk, could be eliminated if bidet seats were used for perineal cleaning. During bathing, the highest exposures to MSD risk factors were observed during transfers and while providing lower limb care. Four tools to reduce exposures were evaluated in a follow-up study. Shoulder muscle activity and exposure to non-neutral postures were reduced when using a short-handled leg-lifter to transfer the legs, while sitting to lift the legs improved back postures but increased demands on the shoulders. A sliding, rotating bench reduced back muscle activity despite an increased use of awkward postures. All participants judged the leg-lifter and sliding, rotating bench to be feasible and desirable for use in the community. The identified tools reduce providers’ exposure to MSD risk factors when assisting with two of the most demanding homecare activities. There is a need to improve access to assistive devices to ensure providers’ occupational safety while preserving their ability to provide client care.Ph.D