Barriers to documenting occupational injuries among personal assistance services workers

BACKGROUND: Personal Assistance Services (PAS) workers provide essential support to disabled and elderly individuals living at home rather than institutions. Occupational injury risks are known, but limitations in occupational injury surveillance prevent assessing injury prevalence. Changing employment arrangements adopted by publicly funded programs may complicate the classification of PAS workers. METHODS: We surveyed state workers' compensation agencies and Financial Management Services organizations used by state Medicaid programs. RESULTS: Changing employment arrangements pose further barriers to classifying and documenting injury, and accessing workers' compensation coverage. Workers' Compensation coverage varies according to employment arrangements of the PAS workers. Financial Management Services organizations vary in their roles for reporting injury. Most frequent activities were providing written information about injury reporting, and reporting injuries to appropriate agencies or insurance companies. CONCLUSIONS: Current limitations undercount the prevalence and consequences of PAS-related occupational injuries among agency workers and largely ignore independent providers. Policy and research recommendations are presented.