Home health employer responsibilities and safety priorities

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.

Pre-visit strategies for the home care worker

• Schedule ahead and communicate the visit with the patient and/or family.
• Be courteous about parking and where to enter the home; ask if pets are in the home.
• Park in a well-lighted area and in a place away from large trees or shrubs that could hide a person.
• Establish care priorities and schedule visits during daylight hours.
• Keep all equipment, supplies and personal belongings locked in the trunk of your vehicle; only bring necessary supplies into the home.   
• Dress professionally so family or residents can identify you as a caregiver.
• When driving alone, keep car windows closed and doors locked.

Visit strategies for the home care worker

• Communicate all services and procedures that will be completed prior to touching the resident.
• Know the resident’s care plan and avoid asking too many questions.
• If a family member or resident behavior begins to escalate, remain calm and caring; do not match threats or give orders.
• Use basic safety precautions, including being alert to the surroundings, and watch for signals of violence, such as shouting, verbal aggression or threatening remarks, weapons or signs of drug or alcohol abuse.
• Firmly establish professional boundaries and recognize your own limits and abilities.
• Be knowledgeable about current care standards and policies related to infectious disease, blood-borne pathogens and sharp injuries.
• Trust your own judgement and avoid situations that do not feel right.
• In the event you feel threatened, leave immediately.
• Notify HHA of unsecured weapons, incidence of violence or verbal abuse.
• Notify law enforcement and HHA if there is a strong odor of chemicals or if someone approaches looking for illegal drugs and or needles.

Be prepared: The Home Health Agency responsibilities to mitigate workplace violence

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.

• Create a zero-tolerance policy for workplace violence.
• Ask employees to report each incident, even if they think it won’t happen again or it might not be serious.
• Develop a written plan for ensuring personal safety, reporting violence, and calling the police.
• Conduct training on the workplace violence plan when the employee is hired and annually thereafter.
• In the case of an unacceptable home environment, advise the patient on working with social service agencies, the local police department, or family members and neighbors to make the home less hazardous so care can continue.
• Provide cell phones to all staff on duty. Keep close track of staff members’ schedules.
• Consider other equipment, such as employer-supplied vehicles, emergency alarms, two-way radios, and personal bright flashlights to enhance safety.
• Establish a no-weapons policy in patient homes. If such a policy is not required, request at a minimum that, before service is provided, all weapons be disabled, removed from the area where care is provided, and stored.
• Train employees to identify different types of illegal drugs and drug paraphernalia
• Analyze reports of violent assault and use them for revising safety procedures
• In the case of patients with psychiatric illness, obtain a consultation for an assessment of potential violent behavior, prior to initiating a home care visit.
• Prior to initiating home care visit have social services evaluate family home situation, provide police support if necessary.
• Prior to initiating each home care visit check with local police about location safety.
• Let workers know about the risks of their assignments and how to assess the safety of their work environment and its surroundings.
• Do not place workers in assignments that compromise safety.

Home care risk assessment and resources

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.

Conclusion

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. 

Disclaimer

Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).

Author

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Rhonda DeMeno

RN, BS, MPM, I-APC, CPHRM
Director Clinical Risk Services -Senior Living Center of Excellence

email Email phone +1 312 288 7704

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