A trade group representing the home health industry is developing recommendations on how home health agencies can protect employees from dangerous situations as more care moves into the home.
The National Association for Home Care and Hospice convened a task force in January to address growing concerns over workplace violence. It is recommending training for staff by law enforcement officers, sending security escorts with nurses into homes and, when necessary, doubling the number of nurses making in-home visits.
Although those recommendations might be a challenge for care providers that are already short-staffed or financially strapped, Andrea Devoti, the association’s executive vice president, said they are practical solutions if providers “want to maintain staff and make them feel that they are supported.”
Workplace violence in healthcare has been on the rise over the past decade. A survey this summer of 1,000 registered nurses across all healthcare settings by the National Nurses United union found more than 8 in 10 registered nurses polled had experienced some form of workplace violence in the past year. That survey followed a 2021 study published by the Centers for Disease Control and Prevention that found 44% of home health nurses reported being physically assaulted on the job, while 19% reported feeling unsafe going into some neighborhoods.
While workplace violence is a risk across all healthcare settings, home healthcare workers are especially vulnerable because they generally work alone and visit unfamiliar settings where neighborhood crime, firearms, illegal drugs and other threats could be present, potentially putting them in danger.
Concerns about such threats escalated after the death two weeks ago of a Connecticut behavioral health nurse whose body was found in the basement of a patient's group home. An attorney representing the worker's family is investigating whether her employer, Dallas-based Elara Caring, was negligent.
“[The family] felt that this likely was a preventable death and everything that we have determined through our investigation so far is confirming that,” said Kelly Reardon, the attorney representing the family.
Elara Caring said in a statement it is considering providing additional protections to its home health staff, such as pepper spray and wearable personal alarms.
The Occupational Safety and Health Administration mandates employers keep track of lone workers regularly during shifts, provide adequate first aid training and supplies, and conduct regular safety hazard assessments to identify and document any potential hazards.
Those requirements may not be enough to protect home health staff in the field if violence continues to escalate, according to some home health companies.
Last year, Innovive Health, a provider of home health services to patients with severe mental illness, strengthened its screening of patients with histories of violence, aggressive behavior and sexual assault. CEO Joseph McDonough said the Medford, Massachusetts-based company is also considering offering employees personal safety alarms and self-defense classes in light of the Connecticut nurse's death.
"This unfortunate incident has accelerated the decision-making process at the company, as is the case with several other agencies across the industry," McDonugh said in an email.
Bayada, which offers home healthcare services in two dozen states, said it is continuously evaluating its safety protocols, which include a 24/7 hotline for staff to report aggressive or violent behavior and staff safety surveys about personal safety.
“We know that workers on the receiving end of rude, aggressive, or violent behavior are more likely to decline in performance or leave their jobs,” a Bayada spokesperson said in an email.
The specific threats home health workers face also could make it hard to recruit workers, who may opt for better-paying jobs at hospitals that have more security, according to Howard Gleckman, a senior fellow at the Urban Institute who studies the home care industry.
“So much of the home health business is word-of-mouth,” said Gleckman. “If the word is out that this work is not safe, people are less likely to do it.”