2016 Best Practices for Preventing Violence In Home Health

Problem of Violence in Healthcare in the United States

Healthcare workers are frequently exposed to a variety of serious or even life threatening hazards. These dangers include overexertion, stress, verbal abuse, weapons including firearms, illegal drugs, and other forms of violence in the home or community. Some stressors of home healthcare workers are; they generally work alone, their work is not directly supervised, they may travel through unsafe neighborhoods, and they might have to face alcohol or drug abusers, family arguments, or dangerous dogs. (NIOSH, 2010).

Problem of Violence in the Home Health Care Setting

The Bureau of Labor and Statistics estimates that home healthcare employment has grown 55% between 2006-2016, making it one of the fastest growing occupations of the past decade and represents one of the fastest growing segments of health care services (BLS, 17 Dec. 2015). Home healthcare workers may work any hour of the day or night and on any day of the week (NIOSH, 2010). Night visits, the lack of safety training and the failure to provide security escorts increases the risks for home health workers. Hazards they may encounter are unique to the home setting. The security for the home and environment is not under the control of the home care agency, thus eliminating the prevention options available in the institutional setting. Home healthcare workers may need to resolve violence issues without immediate help from their employers or coworkers. Home health workers experience more than double the national rate of workplace injuries for all industries, ranking them among the ten highest reported for over-exertion by the Bureau of Labor Statistics. It is imperative to implement a safety risk assessment process to identify areas of concern, develop a safety plan, and educate employees (Gershon and Severson, 2013).


Data and Statistics

World Health Organization defines violence as, “the intentional use of physical force or power, threatened or actual, against oneself, another person, against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation” (Joint Commission, 2012. Pg. 95). Moreover, during 2007 alone, 27,400 recorded injuries occurred among more than 896,800 home healthcare workers. In 2006, 330 non-fatal assaults on home healthcare workers were reported at a rate of 5.5 per 10,000 full time workers, more than 2 times the reported rate for all U.S. workers. In addition, during 2006, five home care workers lost their lives as a result of assaults and violence (NIOSH, 2010).

One survey conducted in 2014 found that 80 percent of nurses reported being attacked on the job within the past year. Healthcare workers experience the highest incidence of nonfatal workplace violence compared to other professions by a wide margin. Attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S., according to data from the Bureau of Labor Statistics (Jacobson, 31 Dec 2014). Between 2011 and 2013, the number of workplace assaults averaged approximately 24,000 annually, with nearly 75% occurring in healthcare settings. Overall, the healthcare sector statistically ranks among one of the industries that are most subject to violence in the United States (Phillips, 28 April 2016).

In the Minnesota Nurses study, the annual incidence of verbal and physical assaults was 39% and 13% respectively. In another large study, 46% of nurses reported some type of workplace violence during their five most recent shifts; of these nurses one third were physically assaulted (Phillips, 28 April 2016). The U.S. Department of Labor’s Bureau of Labor Statistics recently released data showing that nonfatal occupational injuries and illnesses for healthcare support workers increased at almost two-and-a-half times the rate for all private and public sector workers in 2010 ( Bills, 20 July 2013).

Survey results from several different studies have shown 5 to 61% percent of home care workers have experienced some form of workplace violence. 18 to 59% of home care workers reported verbal aggression as the most pervasive, with the highest estimate coming from studies that asked about the occurrence over a home care workers career. Furthermore, studies of home care workers have found that approximately 30% of homecare workers reported being sexually harassed (Glass, Hanson, Laharnar, Moss, and Perrin, 17 January 2015).

Although, training is important to prevent sexual harassment and discrimination in the workplace, other important topics to train on are how to prevent violence in the workplace and how to handle aggressive situations.  Not all agencies are successful in training. 35% of agencies reported training employees on factors predicting violence and aggression, and even fewer trained workers on methods of how to diffuse threatening situations and how to protect themselves if situations were to escalate.  Every year, half a million nurses are victims of violent crimes, including clinicians in the home health industry. In addition, every year, 500,000 nurses from all types of healthcare jobs, hospitals and agencies, are victims of violence. Some 60 percent of community nurses have been verbally abused on the job in the last two years, mainly by family and friends of the patients (Brooks, 4 April 2012).