Workplace violence is a recognized risk in the healthcare industry. Healthcare workers are at an increased risk of workplace violence, with nearly 75% of nonfatal workplace assaults occurring in the healthcare and social assistance industries. Home health workers are key targets; research studies report a range of 18% to 65% of home healthcare workers experience verbal abuse from patients, and as many as 41% of home healthcare workers have reported sexual harassment. Studies further indicate that episodes of workplace violence have made being a visiting nurse or home care worker the most dangerous occupation in the United States, second only to law enforcement. The U.S. Bureau of Labor statistics show that home care workers experience more than 1.5 the national rate of workplace injuries for all industries.
Home care workers are most susceptible to verbal abuse, aggression, threats, sexual harassment and mugging. Other factors contributing to violence in the home health setting may be related to the rise in mental illness, drug abuse and domestic violence, which have the propensity to trigger an increased safety risk for the home care worker.
Because most home care workers practice alone, they must take charge of their own safety. The Home Health Agency (HHA) is responsible for educating the home care workers on specific agency policies, including personal safety, blood-borne pathogens and conducting home care visits.
The National Institute for Occupational Safety and Health (NIOSH) published a Hazard Review for Occupational Hazards in Home Healthcare. The publication highlights employer recommendations for preventing and controlling violence in patients’ homes. HHA employers should consider the following recommendations.
Early reporting of risk exposure from the staff is necessary to drive an effective risk management identification process. A risk management assessment and protection matrix tool can help to identify essential safety interventions before the home health employee visit.
If an adverse home health visit occurs where the staff member was assaulted, injured or threatened, the HHA administrator or safety officer should complete an occurrence record. The occurrence report will assist the HHA in obtaining and tracking information, conducting a root cause analysis of the event and using it for legal defense if necessary.
The Visiting Nurse Occurrence Report is a helpful resource for collecting workplace violence and adverse event occurrence information. The American Society for Health Care Risk Management also has a workplace violence tool kit that can assist the HHA in developing a framework for promoting safe working environments for healthcare providers.
Home healthcare workers provide services to millions of Americans daily. Home health and personal care aides are one of the fastest growing occupations and have a projected growth of 34% from 2019 – 2029. Home health agencies have seen an increase in workplace violence over the past decade due to many factors, including the normalization of violence across the United States.
Workplace violence in the home care environment is complex and requires a multi-faceted approach to prevention. It is incumbent on the HHA to embrace workers’ safety and protect their healthcare workers through setting policy standards, providing comprehensive training to home health workers, conducting pre and post-visit assessments and evaluations, and applying the NIOSH employer recommendations to prevent home care violence.
Home care is a growing workforce. Workplace violence may adversely affect home health workers’ physical and psychological health. Workplace violence can impact the delivery of healthcare services resulting in healthcare workers’ poor health, substance abuse and diminished productivity.
Workplace violence is projected to grow dramatically in the coming years. Home healthcare workers must understand the risk of violence in the workplace. The HHA is responsible for providing support and resources to help mitigate workplace violence. HHA must have a heightened awareness of workplace violence and have safety plans to protect their workers behind closed doors.
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