OHS in Home Care and Home Health Services

Home care safety: when the workplace moves to the patient’s home

In hospital, the patient’s bed is raised, the hoist is mounted on the ceiling, there is a sharps container in every room and help can be called from the corridor at a difficult moment. Home care staff, however, work in a cramped bedroom, next to a low divan, often alone. Home care safety starts with a separate risk assessment that recognises this difference.

This article is written for nurses, care assistants, physiotherapists and health technicians working for private home care companies, home health teams and municipal home care units. Although the work of a home health worker and home care staff differs, most of the risks are shared. The patient’s home is not the employer’s workplace, but it is the place where the employee works. Art. 4 of Law No. 6331 gives the employer the obligation to ensure employees’ work-related health and safety; the home visited, the journey between visits and the vehicle used fall within this scope.

Home assessment before the visit

The risks of working in homes differ from home to home. That is why the general risk assessment is completed with a short home assessment form filled in before or at the first visit. The sources of information are the referring institution, a telephone conversation with the patient’s relatives and observation at the first visit.

Area	Point to check	Possible measure
Access	Stairs, lift, lighting, parking, the area where the home is located	Scheduling visits in daylight, parking close to the door
Patient	Mobility, weight, cognitive state, history of aggression	Equipment and second-person plan
Room	Bed height, space around it, rugs and cables	Changing the bed layout with the family, recommending a hospital bed
Bathroom	Slippery floor, grab rails, cramped space	Recommending grab rails, a non-slip mat, a shower chair
Household	Aggressive family member, alcohol or drug use, weapons	Two-person visits, telephone call before the visit
Animals	Dogs and other pets	Moving the animal to another room for the duration of the visit
Heating and fire	Stoves, gas cylinders, home oxygen equipment and smoking	No smoking or naked flames in a room where oxygen is used
Hygiene	Pests, accumulated waste, clean water	Gloves, apron, visit order

The form is entered not in the patient file but in a separate “visit safety note” that staff can access. That way, an employee going to the home for the first time can learn before the visit, for example, “there is an aggressive dog in the house; call before you knock”. The note contains only safety information, not the patient’s diagnosis.

Patient lifting and transfers: what if there is no equipment?

The most common cause of injury in patients’ homes is strain to the lower back and shoulders. Homes often have no adjustable bed, hoist or transfer equipment; every change of position done by bending forward over a low bed multiplies the load.

Method according to mobility: For a patient who can bear their own weight, guidance is enough; for one who cannot, a slide sheet, transfer board or hoist is used instead of manual lifting.
Bring the equipment to the home: Light equipment such as a slide sheet is kept in the staff member’s bag. For patients needing long-term care, the family is referred for an adjustable bed and hoist, and this recommendation is written in the file.
Second person: Transfers that the assessment shows need two people are not done alone. The visit plan is set up accordingly; help from an untrained family member is not considered sufficient.
Fallen patient: Trying to lift a patient who has fallen to the floor alone can injure both the patient and the employee. The patient is placed in a safe position, checked for injury, and help is called.

For detailed techniques, see our article on back health in patient lifting and transfers.

Risks of working in patients’ homes: environment and fire

The hazards in a home are different from those in a hospital, and most are not under the employee’s control:

Slips and trips: Rug edges, extension cables, wet bathroom floors and dark stairs.
Heating: Homes heated by stoves carry a carbon monoxide risk. An employee who feels a headache or dizziness opens the window, leaves the home and reports the situation; for symptoms, see our article on carbon monoxide poisoning from heaters.
Home oxygen: Smoking, candles and naked flames in a room where an oxygen concentrator or cylinder is used seriously increase the risk of fire. This is discussed with the family and written in the file.
Electricity: Medical devices are not operated from damaged sockets and cables.

Aggressive behaviour and violence

Home care workers encounter aggressive behaviour from two sources: the patient themselves (dementia, delirium, pain, medication effects) and the household (tension, alcohol, unmet expectations). In hospital, help is at the end of the corridor; in a home, there is often nobody.

Keep the exit clear: The employee positions themselves in the room so that nobody can come between them and the door. Their bag and keys are within reach.
De-escalate: Speaking calmly in short sentences, not getting into arguments and postponing the procedure if necessary are practised in training.
Right to leave: Under Art. 13/3 of Law No. 6331, where serious and imminent danger cannot be prevented, the employee leaves the workplace or danger zone and goes to a safe place, and their rights cannot be restricted for this reason. For home care, this means having a written rule: “if you feel threatened, leave and call”. For details, see our article on the right to refuse work.
Reporting: Every incident, including verbal threats, is recorded; the next visit to the same address is made by two people or with a different arrangement.

For the general approach to violence, read our articles on violence against employees and violence in healthcare and the white code.

Lone home visits and time on the road

Home care staff often count as lone workers. The visit arrangement should therefore include these elements:

Daily visit list: The coordinator knows which address the employee will be at and at what time.
Check-in and check-out: The employee sends a notification by text message or app when entering and leaving the home. If the expected check-out does not arrive, the coordinator calls; if they cannot get through, they start the written procedure.
Emergency code: A code phrase is agreed that the employee can use on the phone to ask for help without the household realising.
Vehicle and travel: Driving between visits is working time. Vehicle maintenance, winter tyres and driving hours are planned; you can find the rules in our article on company drivers.

Our article on lone worker safety offers a detailed model for the contact arrangement and the steps to follow when there is no response.

Biological risks, needlestick injuries and waste

Injections, blood sampling, wound dressing and catheter care are also done at home; but a home has no well-lit work surface.

Sharps container: A portable container goes with you on every visit; a used needle is put straight into the container and is not recapped. The container is filled to no more than ¾ (Regulation on the Control of Medical Waste). For what to do after a needlestick, see our article on sharps injuries.
Gloves and hand hygiene: Hand sanitiser and disposable gloves are never missing from the bag.
Vaccination: For employees in contact with blood and body fluids, hepatitis B immunity is assessed together with the workplace physician.
Waste: How medical waste is collected from the home must be written in the organisation’s procedure; it is not thrown into household rubbish.

Biological agents are assessed within the framework of the Regulation on the Prevention of Risks of Exposure to Biological Agents; for details, read our article on occupational infections.

For organisations providing home care and health services in Bursa and the surrounding provinces, we prepare the risk assessment according to the real conditions of home visits. For other topics in the sector, see our healthcare facilities page, and to see specialist and physician hours, our OHS obligation calculator tool.

Frequently Asked Questions

Does a patient’s home count as a workplace, and is it included in the risk assessment?

A patient’s home is not the employer’s workplace, but it is where the employee works. Because the employer is responsible for employees’ work-related health and safety, home visits are included in the risk assessment and completed with a pre-visit home assessment.

Can home care staff lift a patient alone?

Yes, where the patient can bear their own weight and the assessment has found one person sufficient. For patients who cannot bear their own weight, a slide sheet, transfer board or hoist is used; a transfer that the assessment shows needs two people is not done alone.

If a patient’s relative is aggressive, can the employee abandon the visit?

Yes. Where serious and imminent danger cannot be prevented, the employee can leave and go to a safe place, and their rights cannot be restricted for this reason. The incident is recorded and the next visit to the same address is planned with a different arrangement.

Which vaccinations are recommended for home care workers?

For those in contact with blood and body fluids, hepatitis B immunity is the priority. The vaccination programme is planned by the workplace physician according to exposure and the employee’s vaccination history.