Health and Safety Regulations for Elderly Care

Chapter II – Literature Review

Literature Review

Like any other places of work, residential homes for the elderly must have everything in line with the Occupational Health and Safety Authority (OHSA) regulations. It is the duty of the Management (employer) to ensure the health and safety of the residents, employees and visitors. Therefore, the Management is responsible for budgets, facilities and the purchasing of OHS equipment in order to conform to the OHSA. Moreover, the Management needs to understand its role in order to improve the health and safety performance of such homes for the elderly. Commitment and consultation is recommended in order to identify, prioritizing and act on key issues to make real improvements in OHS in this context (L.N. 36 of 2003 section 13.).

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The OHSA states that the Management (employer) has a responsibility to model healthy and safe workplaces for their residents, especially when these residents present medical conditions, mental health issues or a disability. It must provide information, training, instruction and supervision to enable workers to work safely and without risks to their health (L.N. 36 of 2003 section 4). On the other hand, according to section 15 of the same legislation, employees must cooperate, have the knowledge and to care for their own safety as possible and of others in accordance to the training and instructions given by the employer. This also includes reporting of incidents or hazards and also be able to conduct an evacuation in case of fires, earthquakes or bomb threats.

In such environment, employers are obliged to designate persons having the necessary aptitude, capabilities, competence and training to assist in the undertaking of measures with regards to occupational health and safety and the prevention and control of occupational risks as per L.N. 36 of 2003 section 9. The employer shall designate workers who shall be responsible for the implementation of the measures required for fire-fighting and for the evacuation of workers. The names of the persons thus designated shall be entered into a register to be kept at the workplace, and the register shall be maintained and amended as necessary by the employer (L.N. 437 of 2012 section 9.4). Therefore, when organizing an evacuation that includes people with mobility impairments, effective fire safety management should ensure that sufficient people with relevant training are available to take control of the situation (Crowder & Charters, 2013).

However, having residents with mental health conditions or mobility impairments, residential homes for the elderly must set a Personal Emergency Evacuation Plan (PEEP) for every resident. The PEEP explains the method of evacuation to be used by a disabled person in each area of a building (Department of Health, Social Services and Public Safety, 2011). Elderly people are likely to have some kind of disabling condition ranging from a mobility impairment, hearing impairment, visual impairment (blinded or partially sighted)to a cognitive impairment or mental health issues. Therefore, people with such disabling conditions have individual needs and each person should be responded to accordingly (Department of Health, Social Services and Public Safety, 2011). However, some might have more than one-impairment and their needs may be quite specific. For example a person with dual sensory impairment (deaf blind) may have needs which are quite distinct from a person who is either just Deaf or blind. Therefore, in order to ensure that the emergency evacuation plans run smoothly training should include practice on how to evacuate safely each person with all the specific required needs. Regular staff is likely to know the history of each resident and it is assumed that care staff would know what kind of conditions each individual resident lives with. Therefore, they are likely to be the most physically involved if an emergency evacuation occurs. Crowder and Charters (2013) argued that these carers will be the most familiar with evacuees’ requirements and how much time and help will be needed. They therefore they will be most likely the most adequate to evacuate the elderly residents from the building. It was also pointed out that staff that interacts on a regular basis with elderly people with regards to mental health issues will have the knowledge on how to achieve an evacuation without causing undue distress to individuals.

Another important role of front line staff is to have knowledge about health equipment used by some of the residents in case of acute health care treatment. Crowder and Charters (2013) stressed out that patients in acute health care premises may be attached to one or several pieces of equipment as part of their treatment or life support and that the front-line staff should be consulted on whether a person can be disconnected from any of this equipment and for how long.

First Aiders

Having people trained as first aiders can be instrumental since in an emergency there might be the need of immediate medical assistance before professional medical care is available. The law requisite states that an employer must have a considerable number of employees trained in basic first aid procedures; not only in case of fire emergency but for whatever emergency may arise. An employer shall ensure the presence at all times of such a number of first aiders as is adequate and appropriate in the circumstances for rendering first aid to his employees if they are injured or become ill at work (L.N. 348 of 2011 section 5.1).

Evacuation

In their study, Crowder and Charters (2013) argued that the time that passes between the ignition of a fire and the onset of life threatening conditions is the maximum time the occupants have to move to a place of safety. They refer to it as the Available Safe Egress Time (ASET) and the total time needed for evacuation is termed the Required Safe Egress Time (RSET). Therefore, fire detection and the alert (alarm) play an important role to have the most amount of time at hand for a safe evacuation or refuge before the scenario turns into an unacceptable hazard. Evacuation training beforehand is critically important. It has to be frequent enough in order to assure no decrease in efficiency. Crowder and Charters (2013) maintained that lack of familiarity with the task at hand would lead to incorrect handling and lifting procedures, excessive number of people being required to assist and a considerable time loss because people are unsure about their next action. McMahon (2013) argued that there are several steps involved in an emergency evacuation and that the primary step is the recognition of a potential threat and how to take a rapid decision about whether or not to order or request an evacuation. Therefore, fire drills and training is a formal learning experience for all those involved. The University College London (2013) illustrate that the purpose and objective of a fire drill is to:

• Identify any weakness in the fire evacuation plan strategy.
• Test the procedure following any recent alteration or changes to working practices.
• Familiarize new staff and occupants with procedures.
• Test the arrangements for disabled people.
• Identify weaknesses in emergency communications procedures and systems.
• Identify positive and negative reaction of staff with designated responsibilities such as Fire evacuation Marshals.

Safe Egress

All the directions of travel towards the egress must be visible and immediately apparent. Therefore, maps and signs must be posted indicating the current location and the direction of travel to the nearest exit and that each exit must be clearly marked as an exit. Permanent signboards must be used for signs relating to prohibitions, warnings and mandatory requirements and the location and identification of emergency escape routes and first-aid facilities (L.N. 45 of 2002 section 2.1.1). OSHA state that these floor maps with arrows that designate the exit route assignments should be attached in areas prominently to be seen by all employees and should include locations of exits, assembly points, and equipment (such as fire extinguishers, first aid kits, spill kits) that may be needed in an emergency. It is maintained that the employer shall take all the necessary steps to provide and maintain suitable and sufficient emergency routes and exits so that in the event of danger, workers and all persons therein can evacuate all the workplace and all parts thereof quickly and as safely as possible (L.N. 437 of 2012 section 7.1). There must also be an emergency Action Plan and this has to be kept at the work place, it has to be in writing and it has to be available to all members of the residential home for review. Therefore, it is important that training for such an emergency is performed frequently enough to be knowledgeable on how to perform a safe evacuation.

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All exit routes have to be continuous and unobstructed. L.N. 437 of 2012 section 7.2a states that exit routes must be kept clear at all times, and lead as directly as possible to a safe, open air, specifically designated area outside the premises, which shall be on the ground floor. Therefore, the exit access itself has to be clear at all times and not blocked or obstructed and that each opening has to be protected by a self closing fire door that will remain closed or automatically closes in an emergency according to section (8d) of the same legislation.

Provided that no lift shall be used as an emergency route unless such lift has been certified by a mechanical engineer as being safe to be used in emergencies (L.N. 437 of 2012 section 2a). Such context must have lifts which can be used even in a fire evacuation alert. When you have residents with physical impairments, the most practicable way to evacuate in less time possible is to travel beds or wheelchairs to the nearest safe elevator and take them safe down to ground floor. Evacuation lifts will not only improve evacuation time’s brackets for high-rise buildings, but also provide equitable egress for persons with disabling conditions (Worcester Polytechnic Institute, 2013).

Firefighting System and Appliances

Fire fighting systems and appliances are the first aid emergency unit that can be used to domesticate the initial stages of fire. Fire­ detection systems are of vital importance and a necessity at the place of work. For such environment, an addressable fire detection and alarm interface system is the ideal installation over the conventional fire system. This system is able to monitor and control the capabilities of each individual alarm-initiating and signal device (Alberta Group, 2014). This is an automated system having fire/smoke detectors, water sprinklers, air-conditioning system dampers, fire doors/stoppers and the fire alarm system all interfaced while alert signal is sent to the control panel at the main desk where it is constantly monitored 24/7.

Having this system installed fire incidents are identified at their early stage and will prevent or minimize premises damages or harm to the people inside the building. Besides having an ‘intelligent’ automatic system, there must me also manual devices to put out the fire detected at first stage such as proper fire extinguishers, fire blankets, and fire hose pipes among others, depending upon the nature of the context environment as there are a wide range of devices that can be implemented.

The employer shall ensure that workers are adequately instructed and trained as appropriate in the proper use of firefighting equipment as may be required for that work place by the Civil Protection Directorate (L.N. 437 of 2012 section 9.13). By means of ongoing training, drills and simulations, personnel are more likely to respond effectively to fire emergencies since they will increase their confidence. The Department of Health, Social Services and Public Safety (2011) argue that in order to ensure that the plans run smoothly training should include practice evacuations of the premises. Therefore, training is the rehearsal of the residential home’s fire evacuation plan strategy. Provision of a fully integrated PEEP system will improve safety for everyone using the building whilst identifying any weaknesses in any existing evacuation plans (DHSSPS, 2011). In the event of a real fire emergency, such training will lead everyone to know what to do and how to act in a calm and orderly manner. Good communication and appropriate training for staff and management regarding the fire or emergency evacuation process are vital to ensure success (DHSSPS, 2011).