Assisted Living Safety Manual

What Should an Assisted Living Safety Manual Include?

The contents of an Assisted Living Safety Manual should reflect the operations and hazards present at the facility.

A facility serving primarily independent residents may require a different combination of programs than an operation providing extensive personal care, memory care, medication assistance, mobility assistance, or other higher-level resident services.

Depending on operations, the manual may address:

• Assisted living safety responsibilities.
• Hazard assessments.
• Safety inspections.
• Resident assistance and mobility.
• Safe resident handling.
• Ergonomics.
• Memory-care safety.
• Workplace violence prevention.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious disease exposure control.
• Respiratory protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous drugs.
• Housekeeping.
• Laundry.
• Dietary and kitchen operations.
• Slips, trips and falls.
• Facility maintenance.
• Resident transportation.
• Working alone.
• Emergency procedures.

Programs should be selected according to employee duties, services, equipment, chemicals, and workplace hazards actually present.

Assisted Living Safety Program

An effective Assisted Living Safety Program establishes responsibilities and procedures for identifying workplace hazards, protecting employees who assist residents, preventing workplace violence, controlling occupational exposures, maintaining safe residential and support operations, and responding to emergencies.

Management should provide employees with the equipment, training, PPE, staffing support, procedures, and other resources necessary to perform assigned work safely.

Managers, supervisors, and other designated personnel should:

• Identify occupational hazards.
• Conduct workplace assessments.
• Maintain applicable written safety programs.
• Evaluate resident-assistance hazards.
• Provide appropriate assistive equipment.
• Evaluate memory-care hazards.
• Maintain workplace-violence prevention procedures.
• Evaluate blood and infectious-disease exposures.
• Provide required PPE.
• Maintain safe equipment.
• Conduct workplace inspections.
• Correct unsafe conditions.
• Investigate injuries and incidents.
• Provide employee training.
• Maintain applicable records.

Employees should follow established procedures, use required equipment and PPE, obtain assistance when necessary, report unsafe conditions, and promptly report injuries, exposure incidents, threats, assaults, and other workplace hazards.

Assisted Living Hazard Assessments

The facility should evaluate hazards associated with employee job classifications and departments.

Hazard assessments may consider:

• Resident mobility.
• Resident-transfer requirements.
• Dementia and cognitive impairment.
• Resident aggression.
• Blood and body-fluid exposure.
• Sharps.
• Infectious diseases.
• Medication handling.
• Cleaning chemicals.
• Kitchen equipment.
• Laundry equipment.
• Medical equipment.
• Oxygen.
• Slippery floors.
• Maintenance activities.
• Vehicle operation.
• Working alone.
• Outdoor work.

Assessments should be reviewed when resident populations, services, equipment, chemicals, staffing methods, or workplace conditions change significantly.

Assisted Living Safety Inspections

Periodic workplace inspections can help identify hazards before they contribute to employee injuries or illnesses.

Inspections may include:

• Resident rooms or apartments.
• Memory-care areas.
• Bathrooms and shower areas.
• Hallways.
• Dining rooms.
• Kitchens.
• Laundry areas.
• Housekeeping storage.
• Maintenance shops.
• Mechanical rooms.
• Activity areas.
• Exterior walkways.
• Parking areas.
• Emergency exits.
• Resident-assistance equipment.

Identified deficiencies should be documented and corrected in a timely manner.

Job Safety Analysis (JSA/JHA)

A Job Safety Analysis (JSA/JHA) may be useful for assisted-living tasks where a step-by-step hazard analysis can improve employee protection.

Potential JSAs/JHAs may address:

• Assisting resident transfers.
• Bathing assistance.
• Resident repositioning.
• Blood and body-fluid cleanup.
• Sharps handling.
• Laundry operations.
• Kitchen equipment.
• Chemical handling.
• Maintenance work.
• Resident transportation.
• Snow and ice removal.

Resident Assistance and Mobility

Assisted-living employees may help residents with walking, transfers, bathing, toileting, dressing, wheelchair use, and other activities of daily living.

The level of physical assistance required should be evaluated so employees understand how each task can be performed safely.

Considerations may include:

• Resident mobility.
• Ability to bear weight.
• Balance.
• Cognitive ability.
• Ability to follow instructions.
• Resident size and weight.
• Fall risk.
• Required assistance.
• Available equipment.
• Available staff.

Employees should not attempt resident-assistance tasks that exceed their training, physical capability, available assistance, or the limitations of available equipment.

Resident Mobility Assessment

Resident mobility needs should be evaluated and communicated to employees who provide assistance.

The assessment may identify whether the resident requires:

• Independent mobility.
• Standby assistance.
• Limited physical assistance.
• A walker or other mobility aid.
• Transfer belt.
• Wheelchair assistance.
• Sit-to-stand equipment.
• Mechanical lifting equipment.
• Assistance from two or more employees.

Changes in resident condition should prompt reevaluation when appropriate.

Assisting Residents to Stand

Before helping a resident stand, employees should consider:

• Resident stability.
• Weight-bearing ability.
• Footwear.
• Floor condition.
• Chair or bed position.
• Mobility devices.
• Available assistance.

Employees should avoid attempting to lift a resident primarily with their back or upper body.

Resident Transfers

Resident-transfer procedures should reflect the resident’s abilities and assessed needs.

Transfers may include:

• Bed to chair.
• Chair to bed.
• Toilet transfers.
• Shower transfers.
• Vehicle transfers.
• Wheelchair transfers.

Appropriate equipment and assistance should be used when necessary.

Wheelchairs and Walkers

Wheelchairs, walkers, and other mobility devices should be maintained in safe condition.

Employees should report:

• Damaged brakes.
• Loose components.
• Damaged wheels.
• Unstable frames.
• Missing footrests.
• Other defects.

Employees should use appropriate body positioning when pushing or maneuvering residents.

Transfer Belts and Assistive Devices

Transfer belts, slide sheets, transfer boards, and other devices may reduce physical stress when appropriate for the resident and task.

Employees should receive instruction in proper use.

Assistive equipment should be accessible so employees are not encouraged to substitute unsafe manual handling.

Mechanical Lifts — When Applicable

Some assisted-living facilities may use mechanical resident lifts.

Where used, lift equipment should:

• Be appropriate for the resident.
• Have sufficient rated capacity.
• Be maintained in safe condition.
• Be readily available.
• Be used according to manufacturer instructions.

Employees should receive appropriate training before independently operating lift equipment.

Two-Person Assistance

Some resident-assistance activities may require two employees.

When two-person assistance is necessary, appropriate staffing assistance should be available.

Employees should not routinely perform tasks alone that have been assessed as requiring two employees.

Bathing and Toileting Assistance

Bathrooms and shower areas can combine resident-handling hazards with wet and slippery surfaces.

Controls may include:

• Grab bars.
• Shower chairs.
• Transfer devices.
• Slip-resistant surfaces.
• Adequate working space.
• Appropriate footwear.
• Staff assistance.

Employees should evaluate both resident mobility and floor conditions before beginning assistance.

Resident Falls

Employees may instinctively attempt to catch a falling resident and can suffer serious musculoskeletal injuries as a result.

Training should address appropriate responses when a resident loses balance or begins to fall.

Employees should not be expected to support a load beyond their physical capability.

Ergonomics

Assisted-living employees may experience ergonomic stress from:

• Resident assistance.
• Bending over beds.
• Pushing wheelchairs.
• Moving equipment.
• Housekeeping.
• Laundry.
• Food service.
• Material handling.
• Driving.
• Computer work.

Equipment, work practices, job design, and available assistance should be evaluated to reduce unnecessary musculoskeletal stress.

Memory Care Safety

Memory-care operations can create distinctive employee-safety hazards because residents with dementia or cognitive impairment may become confused, frightened, agitated, or physically aggressive.

Employee-safety procedures should consider:

• Known behavioral triggers.
• Previous aggressive behavior.
• Communication techniques.
• Resident routines.
• Environmental conditions.
• Staffing.
• Access to assistance.
• Elopement concerns.
• Emergency procedures.

Relevant employee-safety information should be communicated to staff who work with the resident.

Residents with Dementia

Employees working with residents who have dementia should understand that cognitive impairment can affect communication, judgment, perception, and behavior.

Employees should use approaches consistent with their training and the resident’s care plan.

Employees should not assume that aggressive behavior must simply be accepted as part of working in memory care.

Resident Aggression

Employees may encounter:

• Hitting.
• Kicking.
• Biting.
• Scratching.
• Spitting.
• Grabbing.
• Throwing objects.
• Verbal threats.
• Other aggressive behavior.

Employees should receive training appropriate to the residents and behaviors they may encounter.

Behavioral Warning Signs

Employees should recognize behaviors that may indicate increasing agitation.

These may include:

• Raised voice.
• Pacing.
• Repetitive movements.
• Threatening language.
• Clenched fists.
• Aggressive gestures.
• Attempts to strike.
• Throwing objects.

Employees should obtain assistance before a situation escalates beyond their ability to manage safely.

Known Behavioral Triggers

Where known, employee-safety planning should consider resident-specific triggers that may contribute to agitation or aggression.

Potential factors may include:

• Certain care activities.
• Pain.
• Noise.
• Crowding.
• Fear.
• Confusion.
• Changes in routine.
• Particular times of day.

Appropriate communication and work planning may help reduce employee exposure.

De-Escalation

Employees may use appropriate de-escalation techniques consistent with their training and the resident’s condition.

Employees should:

• Remain calm.
• Communicate respectfully.
• Avoid unnecessary confrontation.
• Maintain appropriate distance.
• Preserve access to an exit.
• Obtain assistance when needed.

De-escalation does not require an employee to remain in an immediately dangerous situation.

Staff Assistance

Employees should have a practical method for obtaining assistance during aggressive or potentially violent incidents.

Methods may include:

• Call buttons.
• Radios.
• Phones.
• Personal alarms.
• Verbal codes.
• Facility communication systems.

Assistance should be available during night and reduced-staffing periods as well as during normal daytime operations.

Resident Elopement and Employee Safety

Employees responding to a resident who leaves or attempts to leave a secure or supervised area may encounter traffic, weather, uneven terrain, aggressive behavior, or other hazards.

Employee procedures should emphasize safe response and communication.

Employees should not place themselves in unnecessary danger while attempting to locate or assist a resident.

Memory-Care Unit Security

Doors, alarms, access controls, and other security systems should be maintained in safe operating condition where used.

Employee procedures should address system malfunctions and emergency release or evacuation requirements.

Workplace Violence Prevention

Assisted-living employees may experience workplace violence from residents, visitors, family members, coworkers, or other individuals.

A Workplace Violence Prevention Program should establish procedures for identifying, reporting, evaluating, and responding to violence and threats.

The program may address:

• Resident aggression.
• Memory-care risks.
• Family and visitor violence.
• Threat assessment.
• Security.
• Staff assistance.
• Emergency communication.
• Incident reporting.
• Post-incident evaluation.

Family and Visitor Violence

Employees may encounter threatening or aggressive behavior from family members or visitors.

Procedures should address:

• Threat reporting.
• Security assistance.
• Visitor restrictions where appropriate.
• Emergency communication.
• Law-enforcement assistance when necessary.

Credible threats should be promptly reported.

Workplace Violence Incident Reporting

Threats, assaults, bites, scratches, and near misses should be reported according to facility procedures.

Incidents should be evaluated for:

• Contributing factors.
• Repeat patterns.
• Resident-specific concerns.
• Environmental conditions.
• Staffing issues.
• Security needs.
• Additional controls.

Employees should not be discouraged from reporting violence because the person involved has dementia or another cognitive condition.

Bloodborne Pathogens — When Applicable

Some assisted-living employees may have reasonably anticipated occupational exposure to human blood or other potentially infectious materials.

Where such exposure exists, applicable employees should be protected according to OSHA’s Bloodborne Pathogens requirements.

The employer should determine exposure based on assigned job duties rather than assuming every assisted-living employee has occupational exposure.

Exposure Determination

Potential exposure may occur during tasks such as:

• Blood glucose testing.
• Injections.
• Wound care.
• Handling contaminated sharps.
• Blood cleanup.
• Certain personal-care activities.

The employer should identify job classifications and tasks involving reasonably anticipated occupational exposure.

Universal Precautions

Employees with occupational exposure should follow applicable Universal Precautions and established exposure-control procedures.

Appropriate engineering controls, work-practice controls, and PPE should be used.

Needlestick and Sharps Safety — When Applicable

Employees may encounter needles, lancets, syringes, and other sharps during resident care.

Where applicable, employees should:

• Use required safer medical devices.
• Dispose of sharps promptly.
• Avoid unnecessary recapping.
• Never reach blindly into waste.
• Report needlesticks immediately.

Sharps Found in Waste or Laundry

Housekeeping and laundry employees may encounter improperly discarded sharps.

Employees should not:

• Reach blindly into trash.
• Reach blindly into soiled linen.
• Manually compress waste bags.
• Hold waste bags against the body.

Improperly discarded sharps should be reported.

Exposure Incidents

Needlesticks, cuts, mucous-membrane splashes, and other potential occupational exposures should be reported immediately.

Applicable post-exposure procedures should begin promptly.

Employees should know how to obtain assistance on every shift.

Infectious Disease Exposure Control

Employees may be exposed to respiratory, gastrointestinal, skin, bloodborne, and other infectious agents.

The facility should evaluate employee exposures and establish appropriate controls.

These may include:

• Hand hygiene.
• PPE.
• Cleaning and disinfection.
• Exposure precautions.
• Respiratory protection where required.
• Employee training.
• Exposure reporting.

Respiratory Infections

Respiratory infections may spread among residents, employees, and visitors.

Controls may include:

• Source control.
• Hand hygiene.
• Appropriate PPE.
• Ventilation measures.
• Respiratory protection when required.
• Isolation or other precautions.
• Employee exposure procedures.

Respiratory Protection — When Required

When respirators are necessary to protect employees from occupational respiratory hazards, the facility should maintain an appropriate Respiratory Protection Program.

Applicable elements may include:

• Hazard evaluation.
• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

Respirator requirements should be based on actual occupational hazards and assigned duties.

Personal Protective Equipment

PPE should be selected according to employee exposures.

Depending on duties, PPE may include:

• Examination gloves.
• Chemical-resistant gloves.
• Safety glasses.
• Goggles.
• Face shields.
• Protective clothing.
• Respiratory protection.
• Protective footwear.
• Hearing protection.

PPE should be readily available where employees need it.

Hazard Communication

Assisted-living facilities may use hazardous chemicals in housekeeping, laundry, maintenance, dietary, grounds, and resident-care operations.

Where applicable, the facility should maintain a Hazard Communication Program addressing:

• Chemical inventories.
• Safety Data Sheets.
• Container labeling.
• Employee training.
• Non-routine tasks.
• Contractor communication.

Cleaning and Disinfecting Chemicals

Employees should use cleaning and disinfecting products according to label instructions and established procedures.

Employees should:

• Use required PPE.
• Follow dilution procedures.
• Maintain labels.
• Provide ventilation when appropriate.
• Avoid unauthorized chemical mixing.
• Report spills and exposures.

Medication Safety — Employee Exposure

Employees who assist with or administer medications may encounter occupational hazards from certain pharmaceutical products.

Employee-safety procedures should reflect:

• Assigned duties.
• Medication hazards.
• Potential skin or inhalation exposure.
• Crushing or manipulating medications.
• Spills.
• Waste.
• Required PPE.

Medication procedures relating to resident care should be addressed separately according to applicable healthcare and licensing requirements.

Hazardous Drugs — When Applicable

Some medications handled in assisted-living facilities may be classified as hazardous drugs.

Where employee exposure is reasonably foreseeable, appropriate engineering controls, work practices, PPE, spill procedures, and training should be used.

Crushing or Manipulating Medications — When Applicable

Crushing, splitting, opening, or otherwise manipulating certain hazardous medications can increase employee exposure.

Employees should follow established procedures and use appropriate equipment and PPE when required.

Oxygen Safety

Some residents may use supplemental oxygen.

Oxygen can accelerate combustion and increase fire severity.

Employees should follow procedures addressing:

• Smoking.
• Open flames.
• Oxygen equipment.
• Cylinder storage.
• Heat sources.
• Electrical equipment.
• Emergency response.

Compressed Gas Cylinders — When Applicable

Compressed oxygen and other medical-gas cylinders should be appropriately secured and protected from damage.

Employees assigned to handle cylinders should understand safe:

• Storage.
• Movement.
• Valve protection.
• Regulator use.
• Emergency procedures.

Medical Equipment Safety

Employees may use or work around:

• Oxygen concentrators.
• Adjustable beds.
• Wheelchairs.
• Resident lifts.
• Nebulizers.
• Monitoring equipment.
• Other medical devices.

Equipment should be used according to manufacturer instructions and facility procedures.

Damaged or malfunctioning equipment should be reported.

Housekeeping Safety

Housekeeping is a significant assisted-living operation because employees routinely clean resident rooms or apartments, bathrooms, common areas, dining areas, and other residential spaces.

Potential hazards include:

• Cleaning chemicals.
• Blood and body fluids.
• Sharps.
• Wet floors.
• Repetitive motion.
• Manual lifting.
• Electrical equipment.
• Waste.

Employees should receive training appropriate to these exposures.

Blood and Body-Fluid Cleanup

Employees assigned to clean blood or other potentially infectious materials should receive appropriate training and PPE.

Procedures should address:

• Area control.
• PPE.
• Cleaning and disinfection.
• Sharps.
• Waste.
• Hand hygiene.
• Exposure reporting.

Wet Floors

Wet floors should be controlled through appropriate cleaning methods, warning signs, barriers, and prompt drying where feasible.

Employees should avoid creating unnecessary slip hazards during cleaning operations.

Housekeeping Ergonomics

Housekeeping work can involve repetitive reaching, pushing, pulling, bending, lifting, and carrying.

Potential controls may include:

• Properly sized tools.
• Lightweight equipment.
• Carts.
• Improved storage.
• Appropriate work methods.
• Reduced unnecessary reaching.

Laundry Safety

Laundry employees may be exposed to:

• Soiled linens.
• Blood and body fluids.
• Sharps.
• Chemicals.
• Hot surfaces.
• Machinery.
• Repetitive motion.
• Material handling.
• Slips and falls.

Laundry procedures should reflect the equipment and work performed.

Handling Soiled Linens

Soiled laundry should be handled in a manner that minimizes unnecessary employee exposure.

Employees should avoid excessive shaking or agitation of contaminated linens.

Appropriate PPE should be used based on anticipated exposure.

Laundry Equipment

Washers, dryers, presses, and other laundry equipment should be maintained in safe condition.

Employees should not bypass guards or interlocks.

Servicing and maintenance should follow applicable hazardous-energy-control procedures.

Laundry Chemicals

Employees should receive information and training concerning detergents, bleaches, sanitizers, and other hazardous products they use.

Required PPE and dilution procedures should be followed.

Dietary and Kitchen Safety

Assisted-living facilities commonly operate kitchens and dining services.

Dietary employees may encounter:

• Knives.
• Slicers.
• Mixers.
• Ovens.
• Hot surfaces.
• Steam.
• Fryers.
• Chemicals.
• Slippery floors.
• Material handling.

Employees should receive task-specific safety training.

Knife Safety

Employees should:

• Use the correct knife for the task.
• Maintain knives in safe condition.
• Use appropriate cutting surfaces.
• Store knives safely.
• Avoid attempting to catch a falling knife.

Damaged cutting tools should be removed from service.

Slicers, Mixers and Powered Kitchen Equipment

Powered kitchen equipment should have required guards and safety devices in place.

Employees should not reach into operating equipment or bypass guards.

Cleaning and servicing should follow applicable procedures.

Burns and Hot Surfaces

Employees should use appropriate protection around:

• Ovens.
• Steam equipment.
• Hot liquids.
• Hot pans.
• Fryers.
• Dishwashing equipment.

Hot equipment should be maintained in safe operating condition.

Food Service Safety

Employee-safety procedures for food service should address occupational hazards such as cuts, burns, machinery, chemicals, lifting, slips and falls, and fire.

Food sanitation and resident food-safety requirements should be addressed separately under applicable food-service requirements.

Slips, Trips and Falls

Assisted-living facilities contain residential, healthcare, dining, housekeeping, and outdoor areas where employees may encounter fall hazards.

Potential hazards include:

• Wet floors.
• Loose rugs.
• Mats.
• Cords.
• Medical equipment.
• Resident belongings.
• Clutter.
• Stairs.
• Poor lighting.
• Ice and snow.

Hazards should be corrected promptly when feasible.

Resident Rooms and Apartments

Resident living spaces may contain furniture, rugs, cords, mobility devices, oxygen tubing, and personal belongings.

Employees should maintain clear working space where possible and report conditions that interfere with safe performance of assigned tasks.

Bathrooms and Shower Areas

Wet floors and resident-assistance activities can increase fall risk.

Controls may include:

• Grab bars.
• Slip-resistant surfaces.
• Appropriate footwear.
• Prompt cleanup.
• Adequate lighting.

Common Areas

Hallways, lounges, activity areas, dining rooms, and other common spaces should be maintained free from unnecessary trip hazards.

Equipment and supplies should not obstruct required walkways or exits.

Exterior Walkways

Sidewalks, ramps, stairs, entrances, and parking areas should be maintained in reasonably safe condition.

Hazards may include:

• Ice.
• Snow.
• Water.
• Uneven pavement.
• Debris.
• Poor lighting.

Walking-Working Surfaces

Floors, stairs, ramps, platforms, and walkways should be maintained in safe condition.

Damaged flooring, loose mats, clutter, cords, and spills should be corrected or controlled promptly.

Facility Maintenance Safety

Maintenance employees may perform electrical, mechanical, plumbing, HVAC, repair, grounds, and construction-related work.

Depending on assigned duties, programs may address:

• Electrical Safety.
• Lockout/Tagout.
• Hand & Power Tools.
• Ladders.
• Machine Guarding.
• Hot Work.
• Hazard Communication.
• PPE.
• Confined Space.

Only appropriately trained and authorized employees should perform specialized work.

Lockout/Tagout — When Applicable

Laundry, kitchen, maintenance, and other equipment may contain hazardous energy.

Where applicable, energy-control procedures should address:

• Shutdown.
• Isolation.
• Lockout or tagout.
• Stored energy.
• Verification.
• Return to service.

Employees should not rely solely on normal operating controls when Lockout/Tagout is required.

Electrical Safety

Employees should report:

• Damaged cords.
• Broken plugs.
• Exposed wiring.
• Damaged receptacles.
• Sparking.
• Shocks.
• Other electrical defects.

Only qualified personnel should perform electrical work requiring specialized training.

Hand and Power Tools

Tools should be appropriate for the task and maintained in safe condition.

Damaged tools should be removed from service.

Employees should use required guards and PPE.

Ladder Safety

Employees should use appropriate ladders or approved access equipment instead of chairs, furniture, boxes, or other unstable surfaces.

Ladders should be inspected and used according to established procedures.

Boiler and Mechanical Rooms — When Applicable

Access to boiler, generator, HVAC, electrical, and other mechanical areas should be appropriately controlled.

These areas should be kept reasonably clear and should not be used for uncontrolled general storage.

Grounds Maintenance

Employees performing grounds work may encounter:

• Mowers.
• Trimmers.
• Hand and power tools.
• Heat.
• Cold.
• Pesticides.
• Traffic.
• Manual lifting.

Applicable procedures should reflect the tasks performed.

Resident Transportation Safety

Assisted-living facilities may transport residents to appointments, shopping, recreation, and other activities.

Transportation procedures should address:

• Authorized drivers.
• Driver qualifications.
• Vehicle inspections.
• Seat-belt use.
• Distracted driving.
• Loading and unloading.
• Wheelchair securement where applicable.
• Backing.
• Accident reporting.
• Emergency procedures.

Loading and Unloading Residents

Employees assisting residents into or out of vehicles should consider:

• Traffic.
• Parking location.
• Resident mobility.
• Vehicle steps.
• Wheelchair lifts.
• Weather.
• Slippery surfaces.
• Available assistance.

Employees should avoid rushing resident loading or unloading.

Wheelchair Securement — When Applicable

Vehicles designed to transport occupied wheelchairs should use appropriate securement systems.

Employees assigned to use these systems should receive appropriate instruction.

Securement equipment should be inspected and maintained in serviceable condition.

Distracted Driving

Employees should not text or use handheld devices while driving.

Drivers should safely park before performing tasks that require attention away from driving.

Schedules should not encourage unsafe driving to remain on time.

Working Alone and Reduced Staffing

Some assisted-living employees may work alone or with reduced staffing during nights or other periods.

Potential concerns include:

• Workplace violence.
• Resident emergencies.
• Maintenance emergencies.
• Security.
• Fire.
• Medical emergencies.
• Inability to obtain lifting assistance.

Procedures should establish how employees can summon additional assistance.

Night Shift Safety

Night-shift employees may encounter:

• Reduced staffing.
• Fatigue.
• Lower lighting.
• Resident confusion.
• Security concerns.
• Isolated work areas.

Appropriate communication and emergency assistance should remain available on all shifts.

Employee Check-In and Communication

Employees working alone in isolated areas may require a method for periodic communication or obtaining assistance.

Procedures should be practical and appropriate to the facility’s staffing and layout.

Shiftwork and Fatigue

Employees may work nights, weekends, overtime, or rotating schedules.

Fatigue can affect:

• Attention.
• Reaction time.
• Decision-making.
• Resident assistance.
• Driving.
• Employee well-being.

Employees should be encouraged to report fatigue that interferes with safe work.

Workplace Security

Facility-security procedures may address:

• Exterior doors.
• Visitor access.
• Parking areas.
• After-hours entry.
• Memory-care access controls.
• Employee communication.
• Suspicious activity.
• Emergency assistance.

Security measures should not interfere with required emergency egress.

Emergency Action Plan

Assisted-living facilities should maintain emergency procedures appropriate to an occupied residential-care environment.

The Emergency Action Plan may address:

• Fire.
• Severe weather.
• Power failure.
• Utility failure.
• Workplace violence.
• Hazardous-material releases.
• Medical emergencies.
• Evacuation.
• Shelter-in-place.

Employees should understand alarms, communication methods, assigned responsibilities, and emergency procedures.

Resident Evacuation Assistance

Some residents may require employee assistance during evacuation or relocation.

Emergency planning should consider:

• Resident mobility.
• Wheelchairs.
• Walkers.
• Memory impairment.
• Evacuation devices.
• Stairways.
• Available staffing.
• Alternative relocation areas.

Employees should receive training appropriate to their assigned emergency responsibilities.

Memory-Care Residents During Emergencies

Residents with dementia may become confused or resist evacuation during an emergency.

Procedures should consider:

• Staffing.
• Communication.
• Resident accountability.
• Secure relocation.
• Safe staff assistance.

Employees should not improvise hazardous lifting or restraint methods during evacuation.

Fire Prevention

Fire-prevention procedures should address hazards associated with:

• Oxygen.
• Smoking.
• Kitchens.
• Laundry equipment.
• Electrical systems.
• Maintenance work.
• Combustible storage.
• Hot work.

Fire-protection equipment and exit routes should remain accessible.

Emergency Exits and Egress

Required exit routes should remain clear.

Furniture, carts, resident equipment, laundry, supplies, and other materials should not obstruct required exits or corridors.

Doors and other egress features should function as required.

Severe Weather

Procedures should address severe weather appropriate to the facility’s location.

Potential events include:

• Tornadoes.
• Hurricanes.
• Flooding.
• Extreme heat.
• Extreme cold.
• Wildfires.
• Winter storms.

Employees should understand shelter, evacuation, and communication procedures.

Power and Utility Failure

Loss of electricity, water, heating, cooling, or other utilities can affect employee and resident safety.

Emergency planning should consider:

• Emergency lighting.
• Oxygen equipment.
• Medical equipment.
• Heating and cooling.
• Food service.
• Elevators.
• Communication.
• Generator operation.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses.

Particular attention should be given to:

• Resident-assistance injuries.
• Needlesticks.
• Blood exposure.
• Bites and scratches.
• Slips and falls.
• Chemical exposure.
• Burns.
• Workplace violence.
• Vehicle incidents.

Prompt reporting allows appropriate medical evaluation and helps identify hazards requiring corrective action.

Injury and Incident Reporting

Employees should be encouraged to report injuries, symptoms, threats, assaults, and near misses.

Reported incidents should be reviewed for:

• Root causes.
• Repeated hazards.
• Resident-related factors.
• Equipment issues.
• Environmental conditions.
• Staffing considerations.
• Needed corrective actions.

Contractor Safety

Assisted-living facilities may use contractors for construction, maintenance, HVAC, electrical work, pest control, landscaping, medical equipment, fire protection, and other services.

Contractor activities should be coordinated with facility operations.

Relevant hazards should be communicated where required.

Assisted Living Safety Training

Safety training should reflect each employee’s assigned duties and workplace exposures.

Depending on responsibilities, training may address:

• Resident assistance.
• Ergonomics.
• Memory-care safety.
• Workplace violence.
• Bloodborne Pathogens.
• Sharps.
• Infectious diseases.
• PPE.
• Respiratory protection.
• Chemical safety.
• Housekeeping.
• Laundry.
• Kitchen safety.
• Vehicle safety.
• Emergency procedures.

Employees should receive task-specific training before independently performing higher-hazard work.

New Employee Safety Orientation

New employees should receive appropriate safety orientation before independently performing assigned work.

Orientation may address:

• General assisted-living hazards.
• Resident assistance.
• Memory-care hazards.
• Workplace violence.
• Bloodborne Pathogens awareness.
• Infectious diseases.
• PPE.
• Hazard Communication.
• Slips and falls.
• Emergency procedures.
• Incident reporting.

Employees assigned to specialized tasks should receive additional training.

Assisted Living JSA/JHA

Assisted-living facilities can use JSAs/JHAs to document safe work practices for selected tasks.

Potential Assisted Living JSAs/JHAs include:

• Resident transfers.
• Bathing assistance.
• Wheelchair assistance.
• Blood and body-fluid cleanup.
• Sharps handling.
• Laundry operations.
• Kitchen equipment.
• Chemical handling.
• Resident transportation.
• Maintenance work.
• Snow and ice removal.

Assisted Living Safety Meetings

Periodic safety meetings can reinforce safe work practices and address current facility concerns.

Potential topics include:

• Resident assistance.
• Memory-care safety.
• Workplace violence.
• Infectious diseases.
• Sharps.
• PPE.
• Slips and falls.
• Housekeeping.
• Kitchen safety.
• Driving.
• Emergency response.

Recordkeeping

Assisted-living facilities should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Injury and illness records.
• Bloodborne Pathogens records.
• Sharps injuries.
• Workplace-violence incidents.
• Resident-handling evaluations.
• Equipment inspections.
• Respiratory Protection records.
• Vehicle incidents.
• Other required program records.

Confidential employee medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on assisted-living operations, additional safety programs may be necessary for:

• Safe Patient/Resident Handling.
• Ergonomics.
• Workplace Violence Prevention.
• Workplace Security.
• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Infectious Disease Exposure Control.
• Tuberculosis Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous Drugs.
• Compressed Gas Cylinders.
• Housekeeping.
• Food Service Safety.
• Vehicle Safety.
• Working Alone.
• Lockout/Tagout.
• Machine Guarding.
• Electrical Safety.
• Hand & Power Tools.
• Ladder Safety.
• Slips, Trips & Falls.
• Walking-Working Surfaces.
• Manual Lifting & Material Handling.
• Heat Stress.
• Cold Stress.
• Emergency Action Plan.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.
• Hazardous Waste Management.
• Contractor Safety.

These programs should be included when employee duties, equipment, chemicals, services, or workplace hazards make them applicable rather than automatically adding programs unrelated to the facility.

Building an Assisted Living Safety Manual

A useful Assisted Living Safety Manual should reflect the actual facility rather than simply adapting a nursing-home, medical-office, or generic healthcare manual.

A facility serving relatively independent residents may require a different combination of programs than an operation providing extensive personal care, memory care, mobility assistance, medication services, transportation, or other resident support.

The manual should consider:

• Resident population.
• Resident mobility.
• Memory-care operations.
• Workplace-violence risks.
• Blood and sharps exposure.
• Infectious diseases.
• Medication services.
• Oxygen.
• Housekeeping.
• Laundry.
• Dietary operations.
• Maintenance.
• Transportation.
• Night staffing.
• Emergency operations.

Selecting the appropriate programs creates a manual that is comprehensive without filling it with procedures unrelated to the work employees actually perform.

Customized Assisted Living Safety Manuals

An Assisted Living Safety Manual can be developed around the facility’s resident population, employee duties, resident-assistance requirements, memory-care operations, workplace-violence risks, infection exposures, housekeeping, laundry, dietary operations, maintenance activities, transportation, medical equipment, and other occupational hazards.

The finished manual may incorporate applicable programs for Safe Resident Handling, Ergonomics, Workplace Violence Prevention, Bloodborne Pathogens, Infectious Disease Exposure Control, Respiratory Protection, PPE, Hazard Communication, Housekeeping, Food Service, Vehicle Safety, Lockout/Tagout, Emergency Action Planning, and other hazards present within the operation.

This provides assisted-living, senior-living, and residential-care employers with a practical safety manual organized around the work their employees actually perform.