Memory Care Safety Manual

What Should a Memory Care Safety Manual Include?

The contents of a Memory Care Safety Manual should reflect the resident population, services provided, staffing, facility layout, employee duties, and actual occupational hazards.

Depending on operations, the manual may address:

• Memory care safety responsibilities.
• Hazard assessments.
• Safety inspections.
• Workplace violence prevention.
• Dementia-related aggression.
• Behavioral warning signs.
• Resident triggers.
• De-escalation.
• Care-related aggression.
• Safe resident handling.
• Ergonomics.
• Wandering and elopement.
• Secured-unit safety.
• Employee safety during resident searches.
• Working alone and reduced staffing.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious disease exposure control.
• Personal Protective Equipment.
• Hazard Communication.
• Housekeeping.
• Laundry.
• Dietary and kitchen safety.
• Maintenance.
• Contractor safety.
• Emergency evacuation.
• Fire prevention.

Programs should be selected according to actual employee duties, resident-care activities, facility operations, and workplace hazards.

Memory Care Safety Program

An effective Memory Care Safety Program establishes responsibilities and procedures for identifying occupational hazards, preventing employee injuries, responding to resident aggression, safely assisting residents, maintaining secure work areas, and preparing employees for emergencies involving residents with cognitive impairment.

Management should provide the staffing resources, communication systems, equipment, PPE, training, procedures, and other controls necessary for employees to perform assigned work safely.

Managers, supervisors, and designated safety personnel should:

• Identify workplace hazards.
• Evaluate workplace-violence risks.
• Maintain appropriate resident-handling procedures.
• Provide methods for employees to obtain assistance.
• Evaluate incidents involving resident aggression.
• Maintain applicable written safety programs.
• Conduct safety inspections.
• Provide required PPE.
• Maintain equipment in safe condition.
• Coordinate emergency procedures.
• Investigate occupational injuries and exposures.
• Correct identified hazards.
• Provide employee training.
• Maintain applicable records.

Employees should follow established procedures, use required equipment and PPE, recognize changing resident behavior, obtain assistance when necessary, and promptly report injuries, exposures, threats, assaults, unsafe conditions, and other workplace hazards.

Memory Care Hazard Assessments

Hazard assessments should consider the unique interaction between employee duties, resident behavior, and the physical environment.

Potential hazards may include:

• Resident aggression.
• Biting, scratching, kicking, hitting, or grabbing.
• Resistance during personal care.
• Unsafe resident handling.
• Resident falls.
• Blood and body fluids.
• Needles and sharps.
• Infectious diseases.
• Cleaning chemicals.
• Wet floors.
• Secured doors.
• Resident elopement.
• Working alone.
• Reduced staffing.
• Tools and maintenance activities.
• Kitchen equipment.
• Emergency evacuation.

Assessments should be reviewed when resident needs, staffing, equipment, facility conditions, or work practices change significantly.

Memory Care Safety Inspections

Periodic safety inspections may include:

• Resident rooms.
• Hallways.
• Bathrooms.
• Dining areas.
• Activity areas.
• Secured doors.
• Outdoor areas.
• Housekeeping areas.
• Laundry.
• Kitchens.
• Medication areas.
• Maintenance areas.
• Emergency exits.
• Employee work areas.

Inspections should consider hazards to employees as well as conditions that could cause residents to behave unpredictably or interfere with employees performing work safely.

Workplace Violence Prevention

Memory care employees may be exposed to physical aggression from residents whose behavior is affected by dementia, cognitive impairment, confusion, fear, pain, or other conditions.

Workplace-violence prevention procedures should address:

• Resident aggression.
• Behavioral warning signs.
• Known triggers.
• De-escalation.
• Care-related aggression.
• Staff communication.
• Obtaining assistance.
• High-risk activities.
• Incident reporting.
• Post-incident evaluation.

Employees should understand that dementia-related behavior can still cause serious occupational injuries even when the resident does not intend to harm the employee.

Dementia-Related Aggression

Employees may encounter residents who:

• Strike.
• Kick.
• Bite.
• Scratch.
• Grab.
• Push.
• Pinch.
• Spit.
• Throw objects.
• Resist care.
• Block movement.
• Become physically agitated.

Employees should receive training appropriate to the resident population and their assigned duties.

Behavioral Warning Signs

Employees should be alert for changes that may indicate increasing agitation.

Potential warning signs may include:

• Raised voice.
• Pacing.
• Repetitive movements.
• Increased physical tension.
• Clenched hands.
• Attempting to leave.
• Pulling away.
• Verbal threats.
• Sudden changes in behavior.
• Increased resistance to care.

Employees should use available information about the individual resident rather than assuming all residents display the same warning signs.

Identifying Resident Triggers

Behavioral escalation may be associated with conditions such as:

• Pain.
• Fear.
• Confusion.
• Noise.
• Crowding.
• Unfamiliar employees.
• Changes in routine.
• Personal-care activities.
• Hunger or thirst.
• Fatigue.
• Environmental stimulation.
• Communication difficulties.

Recognizing patterns can help employees modify their approach and reduce unnecessary exposure to aggressive behavior.

Resident-Specific Safety Information

Relevant information concerning known behaviors, triggers, assistance needs, and employee-safety concerns should be communicated to employees who provide care.

Employees beginning a shift or assuming responsibility for a resident should receive important safety information concerning significant changes when appropriate.

Dementia-Sensitive De-Escation

Employees should use de-escalation methods appropriate to residents with cognitive impairment.

Depending on the circumstances, employees may:

• Approach calmly.
• Identify themselves.
• Use simple communication.
• Maintain a non-threatening posture.
• Allow additional processing time.
• Avoid unnecessary confrontation.
• Redirect attention.
• Reduce environmental stimulation.
• Maintain appropriate personal space.
• Obtain assistance.

Employees should avoid escalating a confrontation merely to complete a non-emergency task.

Avoiding Unnecessary Confrontation

Arguing with a confused resident or attempting to force the resident to accept an employee’s perception of events can increase agitation.

Where consistent with the resident’s care procedures and immediate safety needs, employees should use calm communication, redirection, and other approved approaches.

Employee safety should remain part of the decision to continue, pause, or modify an activity.

Maintaining Personal Space

Employees should maintain sufficient distance to respond to sudden movement when circumstances permit.

Employees should avoid unnecessarily cornering or surrounding an agitated resident.

Work positioning should preserve the employee’s ability to withdraw and obtain assistance.

When to Disengage

Employees should recognize when continuing an interaction is increasing the risk of injury.

When appropriate, employees may need to:

• Pause the task.
• Step away.
• Allow the resident time to calm.
• Obtain another employee.
• Notify a supervisor or nurse.
• Modify the approach.

Emergency situations may require different actions according to facility procedures.

Care-Related Aggression

Aggressive behavior may occur during routine care activities when a resident does not understand what is occurring or perceives assistance as threatening.

Higher-risk activities may include:

• Bathing.
• Dressing.
• Toileting.
• Repositioning.
• Transfers.
• Personal hygiene.
• Changing clothing or bedding.
• Medication assistance where applicable.

Employees should consider resident behavior and obtain additional assistance when necessary.

Bathing and Personal Care

Bathing and personal-care activities can place employees in close physical proximity to residents and may trigger resistance.

Employees should:

• Explain actions simply.
• Avoid unnecessary rushing.
• Watch for increasing agitation.
• Maintain safe positioning.
• Obtain assistance when necessary.
• Pause non-emergency care when continuing would create unnecessary danger.

Toileting Assistance

Toileting may combine resident-handling hazards with close physical contact and behavioral unpredictability.

Employees should evaluate:

• Resident mobility.
• Ability to follow instructions.
• Current behavior.
• Available grab bars or equipment.
• Required assistance.

Employees should obtain additional help when the task cannot be safely performed alone.

Dressing and Personal Hygiene

Employees should avoid forceful attempts to complete dressing or hygiene activities when a resident becomes increasingly combative.

Approved redirection, additional assistance, or postponing a non-emergency task may reduce the likelihood of employee injury.

Staff Assistance

Employees should have a practical method for obtaining assistance when resident behavior escalates.

Methods may include:

• Radios.
• Call systems.
• Phones.
• Personal alarm devices.
• Verbal calls for assistance.
• Other facility communication systems.

Employees should understand how and when to summon help.

Workplace Violence Incident Reporting

Employees should promptly report:

• Assaults.
• Bites.
• Scratches.
• Kicks.
• Punches.
• Threats.
• Near misses.
• Other significant aggressive behavior.

Employees should not be discouraged from reporting an incident merely because aggression is associated with a resident’s cognitive impairment.

Post-Incident Evaluation

Significant aggression incidents should be evaluated to identify contributing factors and preventive measures.

The evaluation may consider:

• Activity being performed.
• Known resident triggers.
• Staffing.
• Environment.
• Communication.
• Employee positioning.
• Assistance availability.
• Changes in resident condition.
• Previous incidents.

Corrective actions should be communicated to affected employees.

Safe Resident Handling in Memory Care

Memory care employees may assist residents with transfers, repositioning, walking, toileting, bathing, and other mobility activities.

Cognitive impairment can make these tasks unpredictable because a resident may:

• Forget instructions.
• Misunderstand directions.
• Resist movement.
• Grab an employee.
• Suddenly sit down.
• Change direction.
• Attempt to walk away.
• Become frightened.

Resident-handling procedures should account for both physical ability and behavior.

Resident Handling Assessments

Resident-handling needs should be evaluated so employees know the appropriate equipment, assistance, and procedures to use.

Considerations may include:

• Weight-bearing ability.
• Mobility.
• Balance.
• Ability to follow instructions.
• Cognitive status.
• Behavioral history.
• Required equipment.
• Number of employees needed.

Changes that affect safe handling should be communicated to affected employees.

Mechanical Lifts and Assistive Devices

Mechanical lifting equipment and other assistive devices should be used when appropriate to reduce unnecessary manual lifting.

Equipment may include:

• Full-body lifts.
• Sit-to-stand devices.
• Transfer aids.
• Slide sheets.
• Transfer boards.
• Other mobility equipment.

Employees should receive appropriate training before independently using equipment.

Lift Equipment Inspection

Resident-lifting equipment should be inspected and maintained according to manufacturer instructions and facility procedures.

Employees should report:

• Damaged slings.
• Worn straps.
• Defective controls.
• Low batteries.
• Damaged wheels.
• Missing components.
• Other defects.

Defective equipment should be removed from service or otherwise controlled until repaired.

Two-Person Assistance

When a resident requires two-person assistance, appropriate staffing should be available to perform the task.

Employees should not routinely attempt a two-person transfer alone because assistance is inconvenient or temporarily unavailable.

Responding to Resident Falls

Employees may be injured while attempting to stop or lift a falling resident.

Employees should follow facility procedures for responding to resident falls and should avoid unsafe manual lifting.

After a fall, appropriate personnel should evaluate the resident before movement as required by facility procedures.

Fall Recovery

When a resident cannot safely rise with minimal assistance, appropriate equipment and assistance should be used.

Employees should not manually lift a dependent resident from the floor when safer equipment or methods are available.

Ergonomics

Memory care work may expose employees to ergonomic stress from:

• Resident handling.
• Repositioning.
• Bathing.
• Toileting.
• Bending over beds.
• Pushing wheelchairs.
• Moving equipment.
• Laundry.
• Housekeeping.
• Dietary work.

Engineering controls, assistive equipment, work practices, and staffing should be considered to reduce unnecessary physical stress.

Wandering and Elopement

Residents with cognitive impairment may wander within the facility or attempt to leave secured areas.

Although wandering and elopement primarily involve resident safety, they can also affect employee duties, emergency response, workload, security, and exposure to hazards during searches.

Facility procedures should clearly establish employee responsibilities.

Exit-Seeking Behavior

Employees should recognize resident behaviors that may indicate an increased likelihood of attempting to leave a secured area.

Relevant information should be communicated to employees responsible for resident supervision and security.

Secured Memory Care Areas

Secured areas may use:

• Access-controlled doors.
• Door alarms.
• Keypads.
• Electronic locks.
• Wander-management systems.
• Other security measures.

Employees should understand the systems used by the facility and should promptly report defects.

Door Security

Employees should avoid defeating security measures by:

• Propping secured doors open.
• Sharing access codes improperly.
• Allowing unauthorized persons to follow through controlled doors.
• Ignoring malfunctioning alarms.

Security procedures should remain consistent with applicable emergency-egress requirements.

Visitor Entry and Exit

Visitors can unintentionally create an opportunity for a resident to leave a secured area.

Employees should follow facility procedures for:

• Visitor access.
• Door operation.
• Resident supervision.
• Entry and departure.
• Reporting security concerns.

Outdoor Memory Care Areas

Secured courtyards and other outdoor areas should be included in safety inspections.

Potential concerns include:

• Gates.
• Fences.
• Walking surfaces.
• Heat.
• Cold.
• Water features.
• Landscaping.
• Maintenance activities.
• Tools and equipment.

Missing Resident Response

The facility should maintain procedures for responding when a resident cannot be located.

Procedures may address:

• Immediate notification.
• Assigned search areas.
• Facility search.
• Exterior search.
• Employee communication.
• Resident description.
• Law-enforcement notification.
• Family notification as appropriate.
• Search termination and employee recall.

Employees should understand their assigned responsibilities before an incident occurs.

Employee Safety During Resident Searches

Urgency in locating a missing resident does not eliminate hazards to employees participating in the search.

Potential hazards may include:

• Traffic.
• Parking lots.
• Darkness.
• Extreme heat.
• Extreme cold.
• Rain or snow.
• Uneven terrain.
• Water.
• Neighborhood hazards.
• Working alone.

Search procedures should consider employee safety while maintaining an effective response.

Search Communication

Employees participating in a search should have a method for receiving instructions and updates.

Communication may include:

• Radios.
• Phones.
• Assigned search teams.
• Central coordination.

Employees should be promptly notified when the resident is located so unnecessary searching does not continue.

Memory Care Security and Emergency Egress

Security systems used to prevent elopement should not create unaddressed emergency-egress hazards.

Employees should understand:

• Normal door operation.
• Emergency release procedures.
• Fire-alarm interfaces.
• Access-control systems.
• Manual overrides where provided.
• Evacuation procedures.

Defective security or egress equipment should be reported promptly.

Working Alone or With Reduced Staffing

Some employees may work in memory care areas during periods of reduced staffing, particularly at night or during early morning hours.

Potential concerns include:

• Resident aggression.
• Two-person care tasks.
• Medical emergencies.
• Elopement.
• Employee injury.
• Delayed assistance.

Staffing and communication procedures should consider foreseeable employee-safety needs.

Night-Shift Safety

Night-shift employees should have a reliable method for obtaining assistance.

Employees should understand:

• Who is available.
• How to summon help.
• Emergency communication procedures.
• Security procedures.
• High-risk resident concerns.

Employees should not perform tasks requiring additional personnel without the necessary assistance.

Bloodborne Pathogens — When Occupational Exposure Exists

Memory care employees may perform tasks involving reasonably anticipated exposure to human blood or other potentially infectious materials.

Where occupational exposure exists, the employer should maintain an appropriate Exposure Control Plan and implement applicable Bloodborne Pathogens requirements.

Potential tasks may include:

• Wound care.
• Blood glucose testing.
• Injections.
• Blood cleanup.
• Handling contaminated materials.
• Other resident-care activities.

Exposure Determination

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

Coverage should be based on actual employee duties rather than assuming that every memory care employee has occupational exposure.

Needlestick and Sharps Safety

Employees whose duties involve needles, lancets, syringes, or other sharps should follow applicable sharps-safety procedures.

Sharps should be promptly placed in appropriate sharps containers.

Needlesticks and other exposure incidents should be immediately reported.

Blood and Body-Fluid Cleanup

Employees assigned to clean blood or OPIM should use appropriate PPE and established cleanup procedures.

Employees without appropriate training or protection should not perform blood cleanup.

Infectious Disease Exposure Control

Close resident contact can expose memory care employees to respiratory and other infectious diseases.

Depending on workplace hazards, procedures may address:

• Hand hygiene.
• Cleaning and disinfection.
• PPE.
• Respiratory infections.
• Exposure reporting.
• Respiratory protection where required.
• Tuberculosis where applicable.

Respiratory Protection — When Required

When respirators are required 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.

Personal Protective Equipment

PPE should be selected according to employee hazards.

Depending on assigned duties, PPE may include:

• Gloves.
• Eye protection.
• Face protection.
• Protective clothing.
• Chemical-resistant gloves.
• Respiratory protection.
• Other protective equipment.

Employees should receive training on required use, limitations, removal, and disposal or care of PPE.

Hazard Communication

Employees may use hazardous chemicals for:

• Cleaning.
• Disinfection.
• Laundry.
• Maintenance.
• Groundskeeping.
• Other facility operations.

Where applicable, the facility should maintain a Hazard Communication Program addressing chemical inventories, Safety Data Sheets, labeling, employee training, and non-routine tasks.

Chemical Control in Resident Areas

Cleaning products, maintenance chemicals, and other hazardous materials should not be left where residents can access them.

Employees should maintain control of chemical containers and carts while working in resident areas.

Unattended chemicals can create both resident hazards and employee emergency-response situations.

Housekeeping Safety

Housekeeping employees may encounter:

• Cleaning chemicals.
• Blood and body fluids.
• Wet floors.
• Waste.
• Sharps.
• Manual handling.
• Resident interaction.

Housekeeping procedures in memory care areas should also address resident access to carts, chemicals, cords, equipment, and other potentially hazardous items.

Cleaning Carts

Housekeeping carts should be positioned and controlled so residents cannot readily access hazardous chemicals, sharp objects, or equipment.

Employees should not leave carts unattended in resident-accessible areas when hazardous materials are present.

Wet Floors

Wet floors should be controlled and identified promptly.

Employees should consider whether signs, barriers, cords, or cleaning equipment themselves could create additional hazards in areas used by cognitively impaired residents.

Laundry Safety

Laundry employees may encounter:

• Contaminated linens.
• Blood and body fluids.
• Chemicals.
• Hot surfaces.
• Machinery.
• Manual material handling.

Employees should follow appropriate procedures for handling contaminated laundry and operating equipment.

Dietary and Kitchen Safety

Employees working in dining and kitchen operations may encounter:

• Knives.
• Slicers.
• Mixers.
• Hot surfaces.
• Hot liquids.
• Fryers.
• Chemicals.
• Wet floors.

Resident access to kitchen equipment, knives, hot appliances, or hazardous products should be appropriately controlled.

Food Service in Resident Areas

Employees serving meals in memory care areas should consider hazards involving:

• Hot beverages.
• Hot dishes.
• Carts.
• Sharp utensils.
• Spills.
• Resident behavior.

Employees should maintain control of equipment and items that could create a hazard.

Maintenance Work in Memory Care Areas

Maintenance work can introduce tools, ladders, chemicals, electrical equipment, open doors, removed guards, and temporary work areas into spaces occupied by cognitively impaired residents.

Maintenance procedures should address both employee protection and control of the work area.

Tool Control

Tools should not be left unattended where residents can access them.

Employees should account for tools and equipment when completing work in resident areas.

Particular care should be taken with:

• Cutting tools.
• Power tools.
• Sharp tools.
• Small removable parts.
• Electrical equipment.

Ladder Safety

Ladders used in resident areas should be positioned and controlled to prevent unauthorized access or interference.

Where necessary, the work area should be temporarily isolated.

Employees should follow applicable ladder-safety procedures.

Temporary Work Areas

Maintenance work areas should be appropriately separated from residents.

Controls may include:

• Barriers.
• Closed doors.
• Employee attendants.
• Temporary relocation of residents.
• Other methods appropriate to the work.

Barriers should not create unaddressed emergency-egress hazards.

Open Doors During Maintenance

Employees and contractors should not leave normally secured doors open without appropriate controls.

Maintenance activities involving doors, gates, locks, alarms, or access-control systems should be coordinated with facility staff.

Lockout/Tagout — When Applicable

Maintenance and servicing activities involving hazardous energy should follow applicable energy-control procedures.

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

Electrical Safety

Employees should report:

• Damaged cords.
• Broken plugs.
• Exposed wiring.
• Damaged receptacles.
• Electrical shocks.
• Other electrical defects.

Temporary electrical work in resident areas should be appropriately controlled to prevent resident access.

Contractors in Memory Care Areas

Contractors working in memory care areas should receive information necessary to understand relevant facility safety and security procedures.

Topics may include:

• Access control.
• Secured doors.
• Resident interaction.
• Tools.
• Chemicals.
• Work-area isolation.
• Emergency procedures.

Contractor Tool and Equipment Control

Contractors should not leave tools, chemicals, ladders, cords, or other hazardous equipment unattended where residents can access them.

Facility representatives should communicate applicable requirements before work begins.

Slips, Trips and Falls

Potential hazards may include:

• Wet floors.
• Cords.
• Equipment.
• Clutter.
• Uneven surfaces.
• Resident mobility devices.
• Spills.

Hazards should be corrected or controlled promptly.

Walking-Working Surfaces

Floors, stairs, ramps, walkways, and other employee walking-working surfaces should be maintained in safe condition.

Outdoor areas should be inspected for conditions such as:

• Ice.
• Water.
• Uneven pavement.
• Damaged surfaces.
• Poor lighting.

Emergency Action Plan

The facility should maintain emergency procedures appropriate to its operations and resident population.

Potential emergencies include:

• Fire.
• Severe weather.
• Power failure.
• Workplace violence.
• Missing residents.
• Utility failure.
• Medical emergencies.
• Other conditions requiring evacuation or shelter.

Memory care procedures should consider that residents may not understand alarms or emergency instructions.

Emergency Evacuation of Memory Care Residents

Employees may need to assist residents who:

• Do not recognize an alarm.
• Cannot follow evacuation instructions.
• Become frightened.
• Resist movement.
• Wander away from assigned areas.
• Attempt to return to their rooms.
• Require physical assistance.

The Emergency Action Plan should address these foreseeable conditions.

Employee Assignments During Evacuation

Employees should understand their responsibilities for:

• Resident assistance.
• Area checks.
• Door operation.
• Communication.
• Resident accountability.
• Evacuation equipment.
• Assembly-area supervision.

Assignments should be practical for available staffing.

Secured Door Release During Emergencies

Employees should understand how secured doors and access-control systems operate during emergencies.

Emergency procedures should account for:

• Fire alarms.
• Automatic release systems.
• Manual releases.
• Power failures.
• Other system conditions.

Employees should promptly report defective equipment.

Residents Who Resist Evacuation

Employees should be trained in facility procedures for assisting residents who become confused, frightened, or resistant during an emergency.

Planning should consider how additional employees or appropriate equipment can be obtained when needed.

Employees should not improvise unsafe manual lifting methods during evacuation.

Resident Accountability

The facility should maintain an effective method for accounting for residents following evacuation or relocation.

Employees should understand:

• Assembly locations.
• Resident lists or other accountability methods.
• Communication procedures.
• Missing-resident response.

Assembly Area Safety

Residents with cognitive impairment may wander away from an assembly area or attempt to re-enter the building.

Emergency planning should address adequate supervision and security after evacuation.

Fire Prevention

Fire-prevention procedures should address:

• Electrical equipment.
• Cooking equipment.
• Oxygen where present.
• Smoking where permitted.
• Flammable materials.
• Maintenance activities.
• Storage.
• Hot work when applicable.

Fire-protection equipment and exit routes should remain accessible.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses, including:

• Bites.
• Scratches.
• Kicks.
• Strains.
• Sprains.
• Needlesticks.
• Blood exposures.
• Falls.
• Chemical exposures.
• Other injuries.

Prompt reporting allows appropriate evaluation and helps identify recurring hazards.

Bites and Scratches

Resident bites and scratches can cause employee injury and potential exposure concerns.

Employees should:

• Perform appropriate immediate first aid.
• Report the incident.
• Obtain medical evaluation when indicated.
• Follow applicable exposure procedures.

The circumstances should be evaluated to reduce recurrence.

Incident Investigation

Occupational injuries, assaults, near misses, resident-handling incidents, and other significant safety events should be evaluated.

Investigations should focus on contributing factors and corrective actions rather than assuming that an incident was unavoidable because a resident has dementia.

Potential corrective actions may involve:

• Resident-specific procedures.
• Staffing.
• Equipment.
• Communication.
• Environment.
• Training.
• Assistance methods.
• Work practices.

Memory Care Employee Safety Training

Employee training should reflect assigned duties and the hazards associated with working with cognitively impaired residents.

Depending on responsibilities, training may address:

• Dementia and employee safety.
• Behavioral warning signs.
• Resident aggression.
• Workplace violence prevention.
• De-escalation.
• Care-related aggression.
• Safe resident handling.
• Wandering and elopement.
• Missing-resident response.
• Emergency evacuation.
• Working alone.
• Bloodborne Pathogens.
• Infectious diseases.
• PPE.
• Hazard Communication.

New Employee Safety Orientation

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

Orientation may address:

• General memory care hazards.
• Resident aggression.
• Obtaining assistance.
• De-escalation.
• Resident handling.
• Secured doors.
• Elopement procedures.
• Emergency procedures.
• Injury reporting.

Additional task-specific training should be provided according to employee duties.

Job Safety Analysis (JSA/JHA)

Memory care facilities may use JSAs/JHAs for tasks where step-by-step hazard evaluation can improve employee protection.

Potential JSAs/JHAs may include:

• Resident transfers.
• Resident repositioning.
• Bathing assistance.
• Toileting assistance.
• Resident fall recovery.
• Blood and body-fluid cleanup.
• Housekeeping in resident areas.
• Maintenance in secured areas.
• Missing-resident searches.

Memory Care Safety Meetings

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

Potential topics include:

• Resident aggression.
• Behavioral warning signs.
• De-escalation.
• Resident handling.
• Bites and scratches.
• Working alone.
• Elopement response.
• Emergency evacuation.
• Infection prevention.
• Housekeeping and maintenance safety.

Recordkeeping

Memory care facilities should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Injury and illness records.
• Workplace-violence incidents.
• Bloodborne Pathogens records.
• Sharps injuries.
• Respiratory Protection records.
• Safety inspections.
• Equipment inspections.
• Incident investigations.

Employee medical information should be maintained according to applicable confidentiality requirements.

Additional Safety Programs

Depending on memory care operations and employee exposures, additional safety programs may be necessary for:

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

Programs should be included when employee duties, facility operations, equipment, chemicals, resident-care activities, and workplace hazards make them applicable.

Building a Memory Care Safety Manual

A useful Memory Care Safety Manual should reflect the unique employee hazards created when cognitive impairment affects resident behavior, communication, mobility, security, and emergency response.

A memory care community should not simply use a generic assisted-living safety manual without considering hazards such as:

• Dementia-related aggression.
• Behavioral triggers.
• Care resistance.
• De-escalation.
• Resident-handling unpredictability.
• Wandering and elopement.
• Secured units.
• Resident searches.
• Emergency evacuation.
• Reduced staffing.
• Tool and chemical control in resident areas.

The applicable programs should be selected according to the facility’s resident population, services, staffing, layout, equipment, and actual employee exposures.

Customized Memory Care Safety Manuals

A Memory Care Safety Manual can be developed around the facility’s resident population, dementia-care services, workplace-violence risks, behavioral concerns, resident-handling requirements, secured areas, elopement procedures, infection exposures, housekeeping, maintenance activities, staffing, and emergency operations.

The finished manual may incorporate applicable programs for Workplace Violence Prevention, Safe Patient/Resident Handling, Ergonomics, Working Alone, Workplace Security, Bloodborne Pathogens, Needlestick and Sharps Safety, Infectious Disease Exposure Control, Respiratory Protection, PPE, Hazard Communication, Housekeeping, Emergency Action Planning, Fire Prevention, and other hazards present within the operation.

This provides memory care communities and specialized dementia-care units with a practical employee safety manual organized around the work their employees actually perform.