Issues

in Labor Statistics U.S. Department of Labor

Bureau of Labor Statistics

Injuries to Caregivers Working in Patients' Homes

Summary 97-4

February 1997

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 by

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 lostworktime 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

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/

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. Source: Bureau of Labor Statistics, U.S. Department of Labor

Home health 

care services

Private hospitals Total, private industry 0

100

200

300

400

500

Cases per 10,000 full-time workers

The frequency of lost-worktime injuries and how they occur, 1994

474

326

277

Highway accident

Overexertion

Other Other Other

Overexertion Overexertion

Highway accident

Fall on same level

Fall on same level Fall on same level

The frequency of lost-worktime injuries and how they occur, 1994

U.S. Department of Labor

Bureau of Labor Statistics

Highway accident

Overexertion

Fall on same level

Other

Overexertion Overexertion

Fall on same level Fall on same level

Other Other

Source: Bureau of Labor Statistics, U.S. Department of Labor

Home health

care services

Total, private

industry Private hospitals

Cases per 10,000 full-time workers
U.S. Department of Labor

Bureau of Labor Statistics

Washington, DC 20212

Incidence rates for various ways in which lost-worktime injuries occur, 1994

Cases per 10,000 equivalent full-time workers2

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

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

Exposure 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

———————————————————————————————————————————————————————————

Event or exposure1

1Based 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.

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.

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 snowcovered streets, driveways, sidewalks,

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