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By 2030 one billion people worldwide will be 65 years of age or older. While populations in industrially-developed countries are ageing rapidly, the most dramatic increases are occurring in developing countries. Because most elders prefer to be cared for at home, these profound demographic shifts are driving a global need for home care (HC) at an unprecedented rate. As a result, HC aide jobs are among the fastest growing occupations and yet their occupational safety and health (OSH) experience is nearly invisible. The Safe Home Care Project at the University of Massachusetts, Lowell USA, funded by the US National Institute for Occupational Safety and Health, was established to protect and promote the OSH of the HC workforce.We used mixed methods ranging from focus groups to large scale OSH questionnaire surveys, microbiology field studies, and laboratory experimental studies of chemical, biologic, and biomechanical hazards. These studies were performed among HC aides and elders who are HC recipients.HC aides experience numerous OSH hazards similar to hospitals and nursing homes: back injuries from patient lifting; needlestick injuries; respiratory irritant exposures from cleaning and disinfecting; and serious encounters with violence from patients or family members. Aides also experience hazards not seen in institutional settings: exposure to second-hand smoke, risk of fire from patients smoking cigarettes while on oxygen, patients re-using needles for injections and storing them improperly, and lack of medical equipment for patient lifting. Overall, we found that high quality care delivery depends significantly on HC aide safety.HC aides need OSH protections. Despite OSH challenges, the great majority of aides report high job satisfaction due to meaningful relationships with patients and families and to the relative autonomy compared to institutional care work. Interventions should enhance these beneficial aspects of HC work as well as improve OSH.