Combating Workplace Violence in Home Healthcare

Workplace violence is a growing concern in many sectors, but it’s particularly challenging in home healthcare settings. Home health workers provide essential services, often to vulnerable populations, in environments that are not always controlled or predictable.

The U.S. Bureau of Labor and Statistics predicts that the job market for home health and personal care aids will grow by 22% from 2022 to 2032, adding about 804,600 new jobs. This growth is due to the increasing number of older adults and their preference to stay in the comfort of their homes. According to the U.S. Census Bureau, 73 million baby boomers will be older than 65 by 2030. A recent Redfin survey found that 78% of older American homeowners plan to stay in their homes as they age.

As the industry grows, workplace violence in home healthcare will likely increase, too. To help your employees work in a safer environment, we’ll explore this problem and offer some strategies to address it.

Weekly instances of violence

As part of its 2024 Nurse Salary and Job Satisfaction Report, Nurse.com surveyed 1,635 nurses across the post-acute care setting. The survey revealed that 3% of home healthcare nurses experienced weekly instances of workplace violence, and 4% reported experiencing monthly incidences. Nurses shared that they experienced the following forms of violence from a patient or the patient’s family member:

• 59% experienced verbal abuse
• 38% experienced intimidation
• 16% experienced physical assault or abuse
• 7% experienced sexual assault or abuse

Download the 2024 Post-Acute Nurse Salary and Job Satisfaction Report infographic to learn more.

Key risk factors

Several risk factors contribute to the prevalence of workplace violence in the home healthcare industry. According to the American Nurse Journal, clinicians who deliver care in home settings face safety risks due to:

• Working alone, even in high-risk areas.
• Exposure to weapons and illegal drugs.
• Long distance commute from home to home and traveling in unfamiliar neighborhoods.
• Interacting with older people who may become aggressive because of dementia.
• Lack of safety training or security escorts for evening or night home visits.
• Lack of immediate help if a violent incident occurs.

“Home health workers face unique challenges when entering a patient’s home, often stepping into unpredictable and potentially unsafe environments,” said Vince Baiera, BSN, Post-Acute Care Partner at Relias. “The risk of encountering violence is a very real concern, especially when working alone in unfamiliar settings. From navigating unsafe neighborhoods to managing the behavior of cognitively impaired patients, these caregivers are frequently in situations where their safety is compromised. It’s crucial to recognize these risks and prepare our staff accordingly.”

Impact on well-being

Studies have shown that violence in the home healthcare setting can lead to adverse emotional, cognitive, behavioral, physical, and psychosocial effects on staff. Such incidents of violence can profoundly affect healthcare service delivery and care quality, potentially causing decreased productivity, job dissatisfaction, substance use, and suboptimal health among employees. The repercussions of violence in the healthcare sector are far-reaching, including staff burnout, diminished quality of life, and a range of mental health issues, such as emotional exhaustion, suicidal ideation, depression, and anxiety.

The survey for Nurse.com’s 2024 Nurse Salary and Job Satisfaction Report found:

• 50% of the nurses in home healthcare reported that negative interactions with patients and families affected their mental health and well-being.
• 28% of the nurses reported that being a witness to or a victim of workplace violence negatively affected their mental health and well-being.
• 46% of respondents reported feeling burnt out.
• 20% of respondents experienced depression.
• 48% of respondents experienced prolonged stress.

Strategies for creating a safer workplace

Addressing workplace violence in home healthcare requires a comprehensive approach that involves employers, employees, and clients. In a post on the NIOSH Science Blog, researchers from the National Occupational Research Agenda Traumatic Injury Prevention Council suggest prevention measures that employers can take to prevent workplace violence in home healthcare:

Develop standardized protocols:

• Develop a zero-tolerance policy toward workplace violence.
• Form safety committees that involve home healthcare workers.
• Create policies that require regular cell phone contact or check-ins with workers in the field and conducting home visits in pairs or with security escorts.
• Establish rules for visits in homes or neighborhoods where violence has occurred in the past.

Create comprehensive staff training on workplace violence that includes:

• Content specific to home healthcare workers and their work environment.
• Assessing the work environment and surroundings for safety, including the presence of drugs, weapons, and aggressive pets.
• Recognizing signs of imminent violence, such as verbal abuse and aggressive body language.
• Employing verbal de-escalation techniques, as well as escape techniques.
• Recognizing and reporting intimate partner violence and child abuse or neglect.

Conduct post-visit assessments:

• Assess completed visits for violence that occurred during the visit.
• Identify factors contributing to a violent event or hazardous environment and strategies to prevent future occurrences.
• Record events and monitor records for trends in workplace violence and the effectiveness of workplace violence prevention policies and practices.

“Creating a safer work environment in home healthcare requires a multi-faceted approach that involves proactive planning, continuous training, and open communication,” said Baiera. “It’s essential to establish clear protocols, such as regular check-ins and the option of paired visits in high-risk areas. Training staff to recognize early signs of violence and employing de-escalation techniques can be lifesaving. Moreover, after each visit, it’s important to assess any incidents that occurred, identify patterns, and refine our strategies to prevent future occurrences. By taking these steps, we not only protect our employees but also improve the overall quality of care we provide.”