There is no Place for Violence in Home Health

According to the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary,  the annual growth rate for home health spending is predicted to be 6.7 percent by 2020 and will be almost $173 billion annually by 2026, making it higher than any other category tracked and outpacing the U.S. gross domestic product, which is anticipated to increase 4.5 percent per year.  This type of growth means it is key that there are workers to fill home health positions.  And, these employees need to work in a safe environment, which is not always the case.  As home health workers provide medical assistance to ill, elderly, convalescent or disabled persons, unfortunately they are often exposed to potentially serious or even life-threatening hazards while on the job.

Managing Home Health Violence

Every time a home health worker enters a patient’s home, he/she becomes vulnerable to a range of violence, from verbal abuse and stalking to more serious threats dealing with assault or even homicide.  According to a recent state survey of home health workers conducted in Oregon, 50.3 percent experienced verbal aggression and 23.6 percent experienced workplace violence in a single year.  This abuse is not always from the patient either.  Often family members or even others in the patient’s community are the sources of this type of abuse.

To help deal with this grave issue, the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) have teamed up to publish recommendations for avoiding violence in home health.  The policy of “zero tolerance” for any type of violence, including from animals, must start at the top with management.  Home health managers must develop a written policy that is strongly enforced to protect employees and contractors.

All employees and contractors must be responsible for reporting and documenting all incidences of violence, even minor ones.  As many details as possible should be included in every report.

The following guidelines from NIOSH1 will help home health workers to better manage violet situations:

  • Be sure of the locations of patients’ homes and have accurate directions.
  • Keep the windows of your vehicle rolled up and the doors locked.
  • Park in well-lit areas, away from large trees or shrubs where person(s) could hide.
  • Keep equipment, supplies and personal belongings locked in the trunk of your vehicle.
  • Before getting out of your vehicle, check surrounding areas and do not leave the vehicle if there are any threats to your security.
  • Contact your supervisor(s) in the event of threatening circumstances.
  • During visits, you should remain alert and watch for signs of possible violence, such as verbal expressions of anger and frustration, threatening gestures, signs of drug or alcohol use or the presence of weapons. There should be a “zero tolerance” policy for visible weapons.
  • When you are verbally abused in a patient’s home, you should ask the speaker(s) to stop. If the verbal abuse continues, you should leave the patient’s home and notify your supervisor(s) that you have done so.
  • If possible, you should identify more than one exit from the patient’s home and keep a clear path to at least one of them.

Let’s Not Repeat the Past

Unfortunately, many home health employees have experienced violence while on the job.  It is critical to ensure that everyone, from top management to the frontline home health caregiver, are in sync regarding a safe, working environment. We all must strive to help ensure a violent past is not repeated.


1 ©2018 Elizabeth E. Hogue, Esq.  All rights reserved.

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