Why hospital-at-home, other providers are pressing worker safety

At-home care providers are testing strategies to better protect workers who are raising the alarm on workplace safety.

A new survey of more than 400 home healthcare workers found more than half said they experienced or witnessed at least one act of violence or harassment in the workplace, according to Transcend Strategy Group, which conducted the poll on behalf of home care providers. The report, which echoes similar findings from a National Nurses United survey, comes as hospital-at-home programs expand and more care moves to where patients live.

Related: Lawmakers, AHA seek support for health worker anti-violence bill

Home-based care providers are trying to address the issue because concerns about personal safety could make it harder to recruit and retain workers in a competitive job market. The concerns are also coming up in contract negotiations between unions and providers.

But more than a third of the workers polled said they did not think their employer prioritized safety, and fewer than half said they felt they could not leave an unsafe workplace without fear of retaliation from their employer, the report found.

“That one was a bit of a gut punch,” said Nicole McCann-Davis, Transcend Strategy Group senior client advisor and research director. “Every employer wants staff to feel comfortable leaving an unsafe environment, but to see that half don’t feel that way is very concerning.”

The Labor Department’s Occupational Health and Safety Administration defines workplace violence as any act or threat of physical violence, harassment, intimidation or other threatening, disruptive behavior. While OSHA doesn’t require employers to have policies addressing workplace violence, it can cite them for failing to provide a workplace that is “free from recognized hazards that are causing or are likely to cause death or serious physical harm," according to a law from 1970.

In May, the Labor Department fined home health company Elara Caring $161,323 for failing to protect a Connecticut nurse who was killed during a visit to a home last year. Following the incident, the company said it was piloting safety alarms and other forms of worker protection. Elara Caring did respond to a request for comment on whether it has made those safety protocols permanent.

Healthcare workers are about five times more likely than others to be intentionally injured on the job by another person, according to the Labor Department. Those who provide care in the home are at greater risk because they often work by themselves in environments that their employers cannot control, according to a study from the Centers for Disease Control and Prevention.

Safety is a constant worry for Angelica Campos, who provides non-medical home care in the Chicago area. She said patients have shouted at her, spit on her, scratched her and even tried to choke her during her nine years on the job. She said her employer, which she declined to identify, provides little training or education to help staff respond to violence and harassment.

“The only thing they tell us to do is to block, dodge and run. That’s it,” Campos said.

Safety concerns can extend beyond patients’ homes. Hospital-at-home nurses often go alone to unsafe neighborhoods, sometimes late at night, said Nahall Rad, a registered nurse with Mass General Brigham’s Home Hospital program.

Some home-based care providers are looking for ways to improve employee safety through training and the deployment of technology.

AccentCare, which operates in 32 states, requires its home care workers to complete safety training annually, said a company spokesperson. The company also provides workers with a secure communication feature on mobile devices that instantly connects them with on-call support teams if needed, she added.

In addition to safety training and patient screenings, Good Samaritan Society provides nurses in its home health unit with escorts if they raise safety concerns about a patient.

“If we can’t work out an escort, we will cancel service because our staff has to be safe,” said DeeAndra Sandgren, vice president of nursing.

Mass General Brigham has software that lets staff register with the health system upon arrival at a home. The system can track staff throughout the visit to ensure their safety, a spokesperson said. She said the health system will also double up nurses for visits if a staff member raises safety concerns.

But Mass General Brigham’s home hospital nurses think those measures fall short. Approximately 80 nurses unionized this summer and plan to push in contract talks for safety alarms and doubling up nurses on most visits, said Rad, who is involved with the union's organizing campaign.

“We want to ensure that we are safe and we don’t want to wait until something happens,” he added.

Other unions representing home care workers, including Service Employees International Union Healthcare, are also working to address workplace violence and harassment for their members.

Home care workers usually put workforce safety behind pay and benefits as central items in contract negotiations, said Jackie Rodriquez, home care division director for 91,000 SEIU home care workers in Illinois, Indiana, Missouri and Kansas. But she said the union is trying to get both members and employers to better address safety within workers' contracts.

“We know this is an issue across the industry,” Rodriquez said.

The National Alliance for Home Care, a trade group for providers, has been urging members to address workplace safety before it becomes a serious recruitment and retention problem. The issue will be front and center next month at a national conference in Tampa, Florida, said Andrea Devoti, an alliance executive.

“If someone doesn’t feel safe in an organization or feel that they are being dismissed, they are going to go where people are treated better,” Devoti said.