Table 3.

Exemplar Quotes Illustrating Hazards Encountered by Home Health Care Providers

Hazard type	Exemplar quotes
Trip/slip/lift hazards
Trip–clutter	A lot of times you have people who are addicted to the shopping network, and they have boxes  everywhere they’re opening, closing. I’ve had a couple patients like that. This one patient had  newspapers all over the floor, and every time I’d come she’d ask me to pick them, but they were all  over the floor, and you’d slide everywhere. Clothing, sometimes they can’t hang up the clothing so it’s  all over the floor. Just about almost anything you could think of.
Slip/trip	Throw rugs. I think that’s with the older generation more. They seem to have to have rugs in front of  everything∔in front of the stove, in front of the sink, in front of the refrigerator, in front of the doors  all the time. And I help remind that these are dangerous; you could easily fall on them. “Yeah, I know. I  should get rid of them.” But then you go back the next time and they still haven’t.
Lift	She didn’t want to have to be lifted with a Hoyer lift. And so people had to be able to lift∔because she  was a quad, and she had a “trach” and it was ongoing, and so you had to be able to get her out of this  electric wheelchair and get her in her bed. It was very challenging; it was hard.
Slip	I think the number one thing that’s happened to our staff is a lot of back injuries and falls on the ice,  because most of your patients’ homes you go into, they’re homebound, so they can’t shovel the snow  or anything. So by nature of that, you’re walking up to a house that’s already dangerous just in your  own∔and you’re carrying a giant bag with you.
Biohazards
Pet droppings	A lot of pet feces, urine, newspapers around, puppy pads around. They don’t clean them up, don’t think  they need to.
Human waste	We have some patients who are incontinent so bad that the entire house smells of urine and yeah, bad, to  the point of the ammonia smell hurting the staff.
Sharps	The table with all the papers and clutter, this is how we’ve gotten a lot of needle sticks. They will sit at  the table to administer their medications and their shots and stuff. And the client did not dispose of the  needle; it was laying there, and when the aide gathered up the papers, she sustained a needle stick.  We have that one happen a lot.
Pests/rodents
Pests	And then with all that clutter comes bugs∔lots and lots of bugs. That’s a big safety concern for  everyone∔them and us, because we can bring them home with us. They’re living with them and  they’re touching everything.
Pests/rodents	I’ve been in one particular home where I had to deal with mice nests, rat nests, droppings. I’ve been in  various homes that I’ve had to deal with bedbugs and roaches.
Air quality
Tobacco smoke	And there are people that smoke, and they don’t put down their cigarettes for you. And they’ll just keep  smoking, and the house is full of∔you walk into kind of a stagnant∔and it’s not good for anyone, but  they do it anyway.
Lack of  ventilation	There are many homes where there are very strong smells and there’s no ventilation at all.
Fire/burn hazards
Smoking with  oxygen in use	I’m going to refer to is another client actually who was on oxygen and was a heavy, heavy smoker. So he  was chronically smoking with big oxygen canister inside of his house. Actually, it was a tiny apartment,  so it placed the entire apartment complex at risk.
Using stove for  heat	I was exposed to two patients recently that kept their burners on their stove for heat. And so I think that  could be a hazard, especially if you accidentally lean on a stove without you knowing that it’s on.  Because it was hard to see because they were gas burners. It was low, but it’s hard to see that. So  that’s what they were doing to keep their heat going in their house.
Allergens
Pet hair	And then we’ll have pets in the home and maybe a lot of pet hair or pet odor.
Mold/mildew	Mold was a biggie. A lot of houses that were in decayed condition, some of them where the floors were caving  in, and people refused to move. The foundations were clearly rotted. And going back and into those homes  when you would walk in the door, the mold’s smell would be overwhelming and hit you in the face.
Poor lighting
Dim lighting	The lighting would be one I see a lot in the bedrooms. Poor lighting. People want to have their shades  drawn and just the lamp on the bedside on.
Electrical hazards
Inadequate   outlets	Electrical hazards, especially if we were bringing machinery equipment, say a pump to run tube feedings  or something like that, some of the houses weren’t wired with the current outlets, current type of  electricity you needed. And then they didn’t have the three-prong; they had two-prong. Sometimes  people were using multiple extension cords to try and plug things in.
Faulty outlets	Faulty outlets. Just doing the care around the home. Every time you have to plug in the vacuum cleaner.  But I see the outlet is hanging out. It’s dangerous.
Illicit drugs
Marijuana   smoke	I’ve walked into homes just filled with marijuana smoke, just rolling out of the windows
Chemicals
Pesticides	I have patients if they have ants or roaches, then they have sprays or powders and sometimes they’re  sitting on the kitchen table.
Cleaning   products	And the chemicals on top, they’re like things that aren’t closed like bleach or a lot of these places have plugged  up pipes so there’s like drain openers and cleaners they put down the toilet to try and keep them flowing.  And they just leave them open because nine times out of ten there aren’t kids in the house. You stick a  bedside commode on the top of the toilet because it’s not working and then you got this whole thing rocking  and things start spilling and mixing together and∔I mean, fumes that will make you really sick.
Unsafe objects
Penetrating   objects	Nails sticking out of the wall where they had pictures, but there’s not pictures anymore.
Unsafe furniture	One of the homes we went into, we actually saw that one of the legs was broken off, and they had taken  a couple of concrete blocks to hold that side of the bed up. And they didn’t want to get rid of the bed  because it was so sentimental; it meant so much to the family. And they didn’t replace the one leg  that was broke. It was a four-poster bed and so the one poster leg was broken, so they had just taken  concrete block and put it up underneath on that side.
Inadequate workspace
Lack of clean   surfaces	I’ve had people who don’t part with anything just piled on all of these surfaces so that it makes it more  difficult for you to find a clean surface to put your things on. Or if you’re doing a dressing change,  where do you put your supplies and open them up on a safe place? And if the bed is dirty, they haven’t  changed the sheets for a period of time, if they’ve been incontinent.