Manual Handling in Care Homes

In care homes, it is inevitable that some manual handling is required. It is important that this is done correctly and safely so no one is put at unnecessary risk. In the care sector, it is sometimes referred to as ‘moving and handling’ to denote that the load that requires movement or transportation is a person, not an object.

What is manual handling?

The term manual handling is typically associated with the movement or transportation of an object, or load, from point A to point B. Manual handling actually encompasses a range of activities, including lifting, twisting, pushing, pulling, lowering and carrying.

The object or load might be a physical item, an animal or a person.

Manual handling tasks are completed either by hand or by using ‘bodily force’. At work, sometimes workers are assisted with their manual handling tasks by specialist machinery or technology.

It is vital that workers do not overstretch or overburden their bodies at work, whether they are assisted by technology or relying solely on manpower to shift and carry loads around. Whilst machinery can be repaired or replaced, once damaged, the human body can struggle to repair itself adequately. This means that after a work-related accident or injury, some people will have their lives changed forever.

Why is manual handling important in a care home?

An estimated 1.54 million people work in the adult social care sector. Manual handling duties are a regular part of the working day for most employees in care homes including those who work as domestic assistants, kitchen porters and housekeepers, in addition to carers.

Working in a care home might involve the need to handle loads such as:

• Laundry.
• Equipment.
• Refuse/waste.
• Catering supplies.
• People (residents).

Many residents in care homes are elderly and suffering from mobility issues and other problems associated with old age. This means that they often require assistance with day-to-day living, including washing, dressing, and getting in and out of the bath, bed or a wheelchair.

‘Live loads’, such as people, offer their own specific manual handling challenges. Unlike an inanimate object, live loads can be upset or injured by poor manual handling. They also have the potential to move around whilst being moved or handled, to shout, become agitated or generally voice their feelings about the situation.

People also have the potential to give feedback or complain about the way they are handled. It is therefore vital in care homes that best practice is upheld when completing moving and handling tasks to maintain the dignity of the residents and reduce the risk of any injuries or upset.

Regulations around manual handling in care homes

There are no specific limits for the weights that can be lifted at work. Instead, there are general guidelines which state that women should lift a maximum of 16kg, men 25kg.

These weight limits depend on the way the load has to be lifted or carried. If they are carried at shoulder height, they drop to 7kg if held close to the body, 3kg if held away, for women. In care home situations, most manual handling would not be done in this way and the 16kg for women and 25kg for men would apply. However, these are only a guide and employees should always consider any risk factors, including their own health and circumstances.

When requiring their workers to complete manual handling tasks, employers should always consider:

• The size and shape of the load.
• The environment at work.
• Who will be handling the load.
• The task at hand.

In a care home setting, although employers are required to comply with health and safety legislation, including The Manual Handling Operations Regulations 1992, it is not reasonably practical to expect them to be able to eradicate the need for manual handling completely.

To avoid workers incurring injuries, especially to the back, neck, shoulders or arms, employers should:

• Provide mechanical aids to assist where possible, such as hoists or lifting slings.
• Conduct adequate training on manual handling and the use of equipment.
• Have enough staff on shift to assist with manual handling tasks.

What can poor manual handling lead to?

In a care home setting, poor manual handling might look like:

• Someone attempting to handle a load in an inappropriate way, such as too forcefully or by bending their back instead of their knees.
• Someone attempting to handle or move a load that is too heavy for them.
• A job that requires the strength of two or more workers being done by only one.
• Misuse of assistive equipment or use of equipment that is not fit for purpose.
• Workers that are overtired trying to perform manual handling tasks.
• Manual handling tasks being rushed or not properly assessed.
• The circumstances or needs of residents not being considered, or their wishes being ignored.

There can be both short- and long-term consequences of poor manual handling. Some accidents and injuries due to manual handling will present an immediate consequence, such as:

• Pulled muscles.
• Sprains or strains.
• Cuts, scrapes and bruises.
• Broken bones.

In extreme cases, if loads are not handled correctly or health and safety protocols are not adhered to, poor manual handling can result in crushes, slips, trips and falls and even death. In a care home setting, there is also a significant risk of injury to the patient, as well as the employee, if poor manual handling occurs.

Other consequences of poor manual handling can present themselves over time, or get worse over time, especially if occupational hazards at work continue unchecked.

These can include:

• Pain.
• Inflammation.
• Joint problems.
• Back problems.
• Musculoskeletal disorders.
• Arm and leg injuries.
• OOS (Occupational Overuse Syndrome).
• Hernias.

Musculoskeletal disorders (MSDs) are commonly caused, or made worse, by manual handling at work. They usually affect the lower back, hips, hands and feet, ankles, wrists, or hands. The pain is not always localised, and workers can experience the occurrence of different MSDs at the same time.

For the year 2019/20, a Labour Force Survey estimated that of 1.6 million workers suffering from work-related ill health, 30% of these were due to musculoskeletal disorders, second only to anxiety, stress, and depression.

Osteopaths for Industry identified that workers within the fields of nursing and personal care reported a higher rate of musculoskeletal disorders compared to the industry average across all occupations.

This is not surprising, as employees within these fields often must work with heavy loads, especially ‘live loads’, i.e., people, that can be awkward to manoeuvre. They also must perform in high pressured environments that are not always sufficiently staffed, and they have to work long shifts.

The cost to both the employer and employee of poor manual handling can be high. Employers have a duty of care to their workers and if they are found to be negligent and the worker has an accident, they leave themselves open to legal action.

There is also a cost in loss of labour due to sick days taken because of incidents related to manual handling and the impact this has on staff morale, the level of care provided to residents, plus additional costs if agency workers must be drafted in to provide cover.

For employees, injuries due to poor manual handling can cause them significant problems, including:

• Loss of earnings if they must take time off work to recover.
• Physical problems such as pain, swelling, lack of mobility and sleep problems.
• Mental health problems, such as stress or depression.
• Loss of future income.

A loss of earnings can have an immediate impact on workers and their families. Whilst workers are off sick their employer is not required to pay them in full. Depending on the contract of employment, workers may only be eligible for Statutory Sick Pay (currently £96.35 p/w) whilst they take time off to recover, which is often less than an average week’s salary. For those self-employed or earning less than an average of £120 per week, there is no entitlement to SSP.

Health issues due to manual handling injuries, especially those relating to repetitive strain, can be debilitating and extremely painful. Back problems are one of the most common moving and handling injuries. Severe back pain can have a serious impact on a person’s quality of life and ability to perform day-to-day tasks. Some opioid medication that is routinely prescribed to people that are suffering from chronic pain also poses individual risks of addiction.

Mental health can also be impacted, especially if workers suddenly find themselves unable to work for long periods of time. This can lead to stress, anxiety and depression caused by various factors, including financial worries. This can be a vicious cycle, one which can be broken by following health and safety advice and being vigilant about safe practices within the workplace, to minimise the chance of a manual handling injury occurring in the first place.

There is also the risk of a loss of future earnings, especially when people find themselves unable to return to work, or to do the same type of work, due to an injury caused by poor manual handling practice.

There is also significant risk to the residents in a care home setting if workers are absent due to illness or injuries caused by poor manual handling. This could mean they do not receive a satisfactory level of care, are left alone for long periods of time, or must wait for their meals or to be taken to the bathroom.

A care home is a busy and demanding place to work, and residents are usually reliant on staff to perform vital tasks for them. It is also important that staff behave with competency, care, and compassion. If they are short staffed or not physically fit or in pain from poor manual handling, it is unlikely they can perform their duties properly and provide a high level of care.

How to avoid manual handling injuries in care homes

Both employers and employees are responsible for taking action to reduce the instances of manual handling injuries in care homes. Although it is not possible to remove the need for manual handling within care homes, it is possible to mitigate the risks associated with it.

Care home managers should ensure:

• Appropriate assistive equipment is available such as hoists or lifting platforms.
• Regular, clear instruction and training is given, both in person and with posters on display.
• Suitable staffing levels are always maintained.
• Staff are well rested and not expected to perform tasks when they are overtired or impaired.
• The correct amount of time is allocated to perform tasks.

Although not required by law, many care homes have policies in place for carers to work in pairs. It is often recommended for two people to be there to operate a hoist, for example. When carers can work in pairs, they can support one another with moving and handling duties.

When two people are handling a load it does not mean that they can handle twice the weight they would alone – it is recommended that neither exceeds 2/3 of their recommended maximum individual limit.

Employees’ duties

As with any job, employees must put into practice any training they have been given. It is important that they attend training sessions in manual handling, as well as general health and safety, and that they understand what is being asked of them. Each setting’s manual handling policy should be accessible to employees.

Workers in care homes, in addition to undertaking training, should be able to assess risks and not attempt to complete tasks, or use equipment, in a way that puts themselves, their colleagues or their residents at risk. Employees should always feel confident to ask for help or clarification from management at work.

It is also vital that employees behave with empathy and understanding towards care home residents so they can perform tasks safely, efficiently, and compassionately.

Overall, care home employees should:

• Attend training and follow health and safety policy and systems.
• Use equipment in a proper way.
• Listen to residents.
• Ask for help or clarification when needed.
• Inform management of hazards, near misses or accidents.
• Never behave in a way that puts themselves or others at risk.

Many care home residents are vulnerable and could be seriously affected by poor moving and handling.

Employers’ duties

Care homes will have their own manual handling policies in place. These will be informed by risk assessments and current legislation and usually form the backbone of manual handling training within the care home.

Legislation to consider when reviewing moving and handling risks includes:

• Manual Handling Operations Regulations 1992 (MHOR) (as amended 2002).
• Health and Safety at Work etc Act 1974 (HSWA).
• The Management of Health and Safety at Work Regulations 1999.
• Provision and Use of Work Equipment Regulations 1998 (PUWER).
• Lifting Operations and Lifting Equipment Regulations 1998 (LOLER).

Employers have a duty of care to ensure the health and safety all of their employees is upheld. Care home managers also have a responsibility to their residents.

In addition to understanding the above legislation, employers should ensure:

• Employees attend training, which is regularly refreshed; instructions are clear and easy to understand.
• Thorough risk assessments are completed.
• Current legislation is upheld and any changes are noted.
• Staffing levels are appropriate and consistent.
• Any manual handling accidents are investigated, and relevant changes made.
• Equipment is available to assist with manual handling and it is fit for purpose.
• Staff have training on how to use assistive equipment.
• They set a good example; a positive health and safety culture is lead from the top-down.

Manual handling is an inevitable part of care work, due to the fact that the people who require care may have impaired mobility or significant health issues.

Care homes are also busy places which require regular cleaning, laundry services and food preparation. In addition to carers, staff who work in all these departments need to recognise the danger that poor manual handling can pose to both themselves and others.

Managers of care homes need to understand the rules and recommendations around manual handling, not only so they are compliant, but also so they can make their setting a safe and well-run space, where no staff members or residents are placed at unnecessary risk.