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. Recent U.S. Bureau of Labor statistics show that home care workers experience more than double the national rate of workplace injuries for all industries. 

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.

Previsit 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.

HHA 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 using the recommendations as a resource to assist in their workplace safety plans.

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 multifaceted 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. 

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.

Rhonda DeMeno, RN, BS, MPM,  A-IPC, CPHRM, is director clinical risk services – Senior Living Center of Excellence, at WTW.