Care is the work that makes all other work possible.

Introduction

Domestic workers, including house cleaners, child care providers, and home health care aides can face a number of workplace safety risks that may impact their health.

House cleaners or caregivers may be at risk for muscle aches and injuries from repeated bending and lifting. The cleaning products used in the house can cause eye, nose, and throat irritation, and if mixed together may cause serious health effects. Slips and falls and infections are also common risks. Employers can mitigate these risks by providing common sense safety measures.

This guide will help you as the employer with protecting the health and safety of your house cleaner or caregiver. Keeping our workers safe is important.

Worker Rights

Domestic Workers are covered by the Fair Labor Standards Act regardless of their immigration status.

That means they must be paid the minimum wage in your state for all hours worked. In 2024, the minimum wage for D.C. is $17.50; in Maryland the minimum wage is $15.00; and in Virginia the minimum wage is $12.50 and will go up to $13.50 in 2025 and $15.00 by 2026. (There is a very limited exemption from paying the minimum wage for domestic workers employed by a household to provide companionship services for the aged or infirm less than 20 hours a week or for casual babysitting that is irregular and intermittent.)

Most domestic workers are also covered by the overtime provisions of the Fair Labor Standards Act. This means they must be paid overtime at time and a half their regular rate of pay for all hours worked over 40 in a workweek. There is an exemption from overtime pay for domestic workers who live in the employer’s home.

In D.C. and MD, workers have the right to medical care when injured on the job. In D.C. and MD household employers must pay for workers’ compensation insurance for employees—even part-time workers.

Preventing Muscle Aches & Injury

House cleaners and caregivers spend a lot of the day lifting, reaching, pushing, and bending that can put them at risk for back and other muscle injuries. Muscle and other soft tissue injuries can be prevented on the job. The key is to assure workers are not lifting anything too heavy so that they can follow safe lifting practices and can avoid reaching.

Measures to keep workers safe:

Never ask workers to lift things that are too heavy.
If laundry baskets are heavy, workers should be able to break down the load into smaller loads that are easier to carry.
Lifting from the floor places stress on the lower back and can cause muscle strains and injury. Provide training to show workers how to lift by bending at the knees—not the waist. If they have to lift children or laundry from the floor, bending from the knees is the safer way to lift.
Educate workers to carry things they lift in front of them and at waist height. Let them know that twisting while lifting can cause pain.
When making beds, educate workers to bend their knees to tuck in sheets—not bend at the waist.
Workers should not have to kneel for long periods—it can cause knee pain.
Provide dusting and cleaning tools with long handles or provide stools so workers don’t have to reach above their heads to clean surfaces that are too far away. Reaching overhead can cause neck and shoulder pain. Or provide a small ladder that is two sided and remind workers to never stand on the top step.
When dusting or vacuuming, allow workers to take a break to rest their hands. Suggest they alternate using the right and left hands to rest muscles and body parts.

Special Measures for Preventing Back Injuries for Home Care Workers

In almost all cases, home healthcare workers should never lift an adult client by themselves. If client lifting is necessary, employers can provide workers with special “ergonomic assistive” equipment (such as slide boards, slip sheets, rollers, slings, or gait belts). Ergonomics is the science of fitting the job to the worker to reduce stress on muscles and tendons that can lead to painful injuries.

Workers will need to be trained on these “ergonomic” assistive equipment.

Equipment such as adjustable beds, raised toilet seats, shower chairs, and grab bars are also helpful for preventing muscle pain and injury among home care workers. This type of equipment keeps the client at an acceptable lift height and allows the client to help himself or herself during transfer when possible.

Home healthcare workers can also stay safe by following these client-safe lifting procedures:

Move along the side of the client’s bed instead of reaching while performing tasks at the bedside.
When manually moving the client, stand as close as possible to the client without twisting your back, keeping your knees bent and feet apart. To avoid twisting the spine, make sure one foot is in the direction of the move. Using gentle rocking motions can also reduce exertion.
Pulling a client up in bed is easier when the head of the bed is flat or down. Raising the client’s knees and encouraging the client to push (if possible) can also help.
Apply anti-embolism stockings by pushing them on while you are standing at the foot of the bed. You can use less force in this position than standing at the side of the bed.

Preventing Health Risks from Using Cleaning Products

Products used to clean houses have chemicals in them. These chemicals may harm the health of domestic workers.

Chemicals can affect workers’ health in different ways, often depending on how much they are exposed to and how often. The chemicals can cause health effects when they are breathed in as vapors or mists or when it gets on the skin or in the eyes. Some of the chemicals in cleaning products can cause skin rashes, some chemicals can irritate the eye, nose, and throat, and some may cause asthma.

Every person is different and not everyone who breathes in these chemicals or gets them on their skin will experience these effects now or in the future. It is important to limit exposure to these chemicals to prevent possible health effects.

Further, some of the cleaning products we have in our house when mixed together can produce highly dangerous gasses that can cause serious health effects.

To protect the health of our house cleaners and caregivers we need to provide training on how to use products safely to help prevent skin and eye contact when using products, limit the mists and vapors they could breathe in and prevent the dangerous mixing of products that can result in severe health effects.

Provide training to workers to never use two products together or one right after the other. A clear rule to always follow: never mix cleaning products that contain bleach (also known as chlorine bleach) with any product containing ammonia.

Include the following when training workers about the dangers of mixing products:

Never mix bleach with ammonia
Never use two drain cleaners together or one right after another
Never mix bleach and vinegar
Never mix bleach and alcohol based gels
Never mix bleach and rubbing alcohol
Never mix vinegar and hydrogen peroxide
Never mix baking soda and vinegar

When using cleaning products:

Provide gloves to workers to prevent skin contact (even for washing dishes).
Provide training to encourage workers to spray cleaning products onto rags or sponges rather than spray them directly on the walls. This will limit the fumes they breathe in.

The most important step to protect workers from breathing in chemicals is increasing ventilation—increasing the airflow in the room. Make sure workers have well ventilated spaces to work in. Educate workers to:

Leave bathroom or bedroom doors open and open windows if possible when using products. Do not work with cleaning products in enclosed spaces.
Turn on the exhaust ventilation when cleaning in the bathroom.

To further protect ourselves when using cleaning products:

Keep all products in original containers.
Keep containers closed when not in use.
Keep products out of reach of children.
Provide regular soap and water for workers to wash their hands.
Remember to keep doors and if possible windows open to provide increased airflow when workers use cleaning products.
Read the labels of the products that you purchase. If the product contains bleach (also known as chlorine bleach), it will usually be on the label. The chemical name for chlorine bleach will also be listed under ingredients: sodium hypochlorite.
Unfortunately, not all chemicals in cleaning products are listed on the label. Some companies will voluntarily list the ingredients, but many don’t.
Some products are marketed as “green” cleaning chemicals with the expectation that green cleaning products are safer for workers and the environment. However, the word “green” in a name or on a bottle does not ensure that a chemical is safe. Review the cleaning chemicals purchased, including green cleaning products, to understand their health and safety hazards.
Know and post the number for poison control and educate workers to call this number to receive help: 1-800-222-1222.
If a product gets in the eyes, instruct workers to rinse their eyes with cold water immediately for at least 15 minutes. If irritation persists, help them seek medical care.
Educate workers on what to do if a product spills. These procedures should include providing gloves to avoid skin contact when cleaning spills, increase ventilation by opening doors and windows to increase airflow, and if there is the possibility of eye contact, provide protective eye goggles.

Preventing Slips & Falls

Falls can result in severe injury. Falls can be caused by slipping on wet floors, slipping on icy or snowy steps and driveways/patios, and tripping over toys or other objects left on the floor. Uneven floors can also cause trips and floors.

To help keep workers safe:

Workers should wear non-slip shoes—especially when washing floors. Be aware that wet floors are very slippery, especially bathroom tile floors. For child care workers, provide towels and bath mats workers can put on the floor when bathing kids.
Never ask workers to stand on tables or chairs to reach or clean anything. Provide stools or ladders that are two sided. If you require workers to use a ladder, make sure it is placed on an even surface (and workers should never stand on the top step of a ladder). To reach or clean objects that might be close enough to not warrant a step ladder, a low step and sturdy step stool (less than 24 inches) should be provided.
Use ice melt on outside steps and other surfaces to melt the ice.
Workers should wear boots with special non-slip soles to walk outside in the snow or wet weather.
Have kids put away toys as soon as they are done playing with them. Small toys are easy to trip on.

Preventing Infections

During cleaning, child care, or home care, workers can come into contact with bodily fluids or household members that are sick.

To protect ourselves:

Make sure you are providing workers with time to wash their hands frequently with soap and water. They should be able to wash hands thoroughly after contact with food, changing diapers, or other tasks which involve possible contact with bodily fluids. Disposable gloves can also be used during diaper changes but be sure workers also can wash hands following diaper changes. Provide a special diaper pail for disposing of dirty diapers and wipes. Provide hand sanitizers.
If you require your employee to work while any member of the household has an infectious disease such as the flu or COVID, provide masks for workers to wear when inside—it can help prevent them from catching airborne infections. The best masks are the N95 or KN95. Provide workers with time to wash their hands frequently, even if gloves are provided.
If home care workers are required to use or be around needles that deliver medication, the needle must be provided with safety features that prevent caregivers from being stuck. Special containers must also be provided to dispose of needles safely so that you cannot come into contact with the needle.
Provide funds so workers who would like to can get the Hepatitis B vaccination (and other infectious disease prevention vaccines).

Preventing Job Stress

Long hours, often heavy workloads, concerns about job security, or poor communication with their employers can cause mental stress for workers. Over time, stress can increase blood pressure, result in poor sleep, and impact workers’ mental health. It is of utmost importance that employers show respect for workers and let them know how much they are valued. If workers feel their employer does not respect their work, or the employer raises their voice when speaking to them, this can lead to job stress and anxiety.

Being able to communicate openly with employers and raising issues of concern is key to reducing job related stress. Having reasonable and predictable hours and a safe, just, and fair workplace is key to reducing the negative impacts of job stress. Further, mutual respect between workers and employers is key to reducing stress.

Preventing Other Hazards

Equipment must be in good working order: All equipment that workers need to do their job must be in good working order, and they should not use equipment (e.g. vacuum cleaners or toasters) with frayed electrical cords.

Sanitation: To prevent urinary tract infections, workers need access to the bathrooms in your home when they need to use them. Workers also need access to drinking water and sinks to wash their hands.

There are tasks, such as cleaning rodent infestations or cleaning mold on walls from leaks/water damage, that can expose workers to serious health hazards. Cleaning up a pest infestation or mold removal should be done by a professional company trained in mold and pest remediation.

Heat/Cold: Working in temperatures above 80 degrees can cause heat related illness. Workers should stay in the shade as much as possible during high heat days and be provided with a water bottle when outside for more than 15 minutes. Encourage workers to drink a lot of water if they are outside on a high heat day. Workers should be trained on the early signs of heat exhaustion: dizziness, headaches, sweaty skin, high heartbeat, nausea, weakness, and cramps. If they feel any of these early signs, they should get out of the heat and get help FAST!

When temperatures are below normal and wind speed increases, heat leaves your body more rapidly. Encourage workers to dress warmly when going outside to work on cold days and wear loose fitting layers of clothes to keep the heat in. Workers should wear a hat or hood to keep the whole body warm. Hats reduce the amount of body heat that escapes from your head. If they get wet, they should come back indoors to dry off. Provide access to warm liquids so they can warm up when back inside.

Workplace Violence & Sexual Harassment

Domestic workers should never have to face threats of physical force or sexual threats on the job. But workers could be at risk of harassment and violence on the job, sometimes by employers or other members of the family, if they provide care for clients with dementia or other issues that may cause them to behave unpredictably or aggressively, or if there are aggressive animals they encounter in or near the home.

Employers must make sure there is zero risk of violence or harassment on the job. If someone in the house has a history of disruptive or aggressive behavior, the employer must put in place a plan to assure all domestic workers are safe. This should include talking to all household members about the importance of always communicating in a respectful tone to workers and keeping a professional relationship. In addition, dogs or other animals that may pose a risk to workers should be kept in an area that is separate from workers.

Consider that many workers are not familiar with dogs. Even if the dog is not aggressive, this lack of experience can create worry and fear among workers. Employers should train domestic workers on how to best interact with dogs, including how to talk to the dog and how to give the dog treats/food.

First Aid & Emergency Preparedness

Provide a first aid kit or first aid supplies for small injuries that may happen. Make sure you also know and post the number for emergency services to call an ambulance or police.

Importance of Communication with Workers

Mutual respect is a very important part of a domestic worker’s job.

Before they start a job, it’s important to review expectations, job duties, hours, and pay for workers. Having predictable hours and times when they work every week is very important. Further, they need to have input into the tasks to be accomplished and the products used. If responsibilities are to increase, this should first be negotiated with the employee. This will help prevent health problems and injuries related to products, excessive workload, and pace of work.

If you are an employer in D.C., you must have a written service contract with your domestic workers that sets out the weekly schedule including days of the week, start time, end time and number of hours per week; rate of pay; the duties to be performed; and for live in domestic workers, a description of the type and value of lodging provided, time of sleep period, and a personal time allotment.Additional language can be agreed upon by domestic workers and their employers and added to the contract. For example, a domestic worker could ask for the contract to include an agreement that the employer will address concerns about safety and health promptly, or that the employer will pay for additional sick days than required under DC law and/or paid time off not covered under paid sick days.

When there is a risk to their health and safety or other concerns, domestic workers need to be able to communicate this when the situation arises. If they can communicate immediately with employers, or as soon as practicable, that is best.

It is very important that you are able to communicate with workers in a language they understand. If there is a language barrier, use cell phones or other technology to translate and speak to each other.

If you have questions about your responsibilities under the law, contact Hand In Hand: the Domestic Employers Network at paola@domesticemployers.org.