September 28, 2021 / Veronica Stanley and Anthony Oliveri

Preventing Violence Against Home Healthcare Workers

The National Occupational Research Agenda (NORA) councils, supported by CDC and NIOSH, seek to enable research, intervention approaches, and implementation strategies for attaining and sustaining improvements in work practices. There are 10 councils for various industry sectors and seven cross-sector councils focused on categories of health effects or occupational hazards. These councils create agendas with research priorities for the nation.

Along with stakeholders from universities, businesses, government agencies, worker organizations, and other professional organizations, several AIHA members serve on NORA councils. We are AIHA’s representatives to the Traumatic Injury Prevention (TIP) Cross-Sector Council, which focuses on leading causes of injuries in nearly all industry sectors, such as falls, motor vehicle crashes, being caught in or struck by machinery, and workplace violence. Recently, the TIP council authored a post on the NIOSH Science Blog titled “Home Healthcare Workers: A Growing and Diverse Workforce at High Risk for Workplace Violence.” Here, we summarize key information from the NIOSH post about home healthcare work.

Home healthcare workers, including personal care aides, home health aides, nursing assistants, and other care assistants, help clients with bathing, dressing, feeding, and other daily activities. They also help administer medications and perform housekeeping chores. While requirements for formal training and certifications vary, some home healthcare workers include licensed nurses, therapists, and social workers.

Because they primarily work alone, home healthcare workers are at high risk for workplace violence. They often face similar hazards as healthcare workers employed in hospital settings. In addition, the home care environment presents additional risks for home healthcare workers such as unpredictability, decreased control of their work environment, lack of policies and procedures, and insufficient training.

Home healthcare workers can reduce their risk of workplace violence by actively participating in training, following employer policies, reporting incidents to the employer, and participating in safety committees. But employers are primarily responsible for protecting home healthcare workers from workplace violence. Examples of key prevention measures include adopting a zero-tolerance policy toward workplace violence and creating safety committees that feature workers’ participation and input. Employers should also establish policies that require regular cell phone contact or check-ins with home healthcare workers in the field. Home visits should be conducted in pairs or with security escorts. Additional rules may be necessary for visits in homes or neighborhoods where violence has occurred in the past.

Home healthcare workers need comprehensive training on assessing the work environment and surroundings for safety, including the presence of drugs of abuse, drug paraphernalia, weapons, and aggressive pets, and recognizing signs of imminent violence such as verbal abuse and aggressive body language. Training should be provided on techniques for verbal de-escalation as well as escape and egress. Home healthcare workers should also know how to recognize, and be encouraged to report, intimate partner violence and child abuse or neglect.

Finally, employers should work collaboratively with home healthcare workers and safety committees to conduct post-visit assessments. These assessments should include identifying violence that occurred or was imminent, factors that contributed to a violent event or hazardous environment, and strategies to prevent future occurrences. Employers should also record events and monitor records for trends in workplace violence and the effectiveness of workplace violence prevention policies and practices.

For a fuller discussion of strategies employers can use to prevent violence, read the original post on the NIOSH Science Blog. More information about NORA councils appears on the NIOSH website.

For further reading, see “Protecting Home Healthcare Aides: Challenges and Handling for Safe Patient Handling and Mobility” in the April 2019 Synergist and “Preventing Workplace Violence: Strategies for Keeping Work Sites Safe” in the December 2018 Synergist.

Related: AIHA’s Ergonomics Working Group, in partnership with the Human Factors and Ergonomics Society, recently produced a white paper, “Home Health Care Aides: Occupational Health and Safety Challenges and Opportunities,” which is available from the AIHA website (PDF).

Veronica Stanley and Anthony Oliveri

Veronica Stanley, MSPH, CIH, CSP, CESCP, works as adjunct faculty in Workforce Development at Harrisburg Area Community College and is a PhD student at Indiana University of Pennsylvania.

Anthony Oliveri, PhD, MPH, is assistant professor of Medicine in the Division of Occupational and Environmental Medicine at Michigan State University.


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