Reasoning and Risk Factors for Homecare Staff
Many risks come with the job of home healthcare workers. Working alone in high risk areas with known criminal or gang-related activities, pose additional risks to home healthcare workers (Joint Commission, 2012). For example, homes can be in areas subject to high criminality leading to risks to staff during the delivery process. Some patients and patients’ relatives, or people in the area, have been known to threaten and assault home healthcare staff. The majority of these incidents of workplace violence are verbal; many others include assault and battery, domestic violence, stalking, or sexual harassment (Phillips, 28 April 2016). These threats and assaults have included physical and verbal abuse, as well as the use of weapons (EIGA, 17 June 2015). Household risk factors for violence can include the presence of weapons in the home, illicit drug use, and family violence. Given that home healthcare workers provide care in the home of the client, the environment is uncontrolled and more highly varied than that of a traditional healthcare facility (Casteel, Gross, Nocera, and Peek-Asa, 31 Jan 2013).
Home healthcare workers are not only at risk from the household hazards of the client, but from the surrounding community as well, such as robbery, motor vehicle theft, and vandalism (Casteel, Gross, Nocera, and Peek-Asa, 31 Jan 2013). Therefore, home healthcare workers are vulnerable as they face an unprotected and unpredictable environment each time they enter a client’s community and home. The spectrum of violence ranges from verbal abuse, stalking or threats of assault, to homicide (OSHA, 2015).
To add to the risk, there are many safety hazards that appear once the home health worker enters the patient’s home. They have little control over their work environment, which may contain a number of safety and health hazards. Home healthcare workers may encounter unsanitary homes, temperature extremes, homes without safe drinking water, or hostile pets (OSHA, 2015), which can carry the risk of a home healthcare worker being bitten; feeling threatened, or otherwise injured (Bills, 20 July 2013).
With regard to in-home treatment or training of diabetic patients, employers are not responsible for lack of safety devices on needles purchased by patients. Needle sticks and other “sharps” injuries are a serious hazard in any healthcare setting. Contact with contaminated needles, scalpels, broken glass, and other sharps may expose healthcare workers to blood that contains pathogens which pose a grave, potentially lethal risk (OSHA, 2015). Risks of needle stick injury information include safety hazards with syringes because they are not disposed of properly. Distractions that include pets and children also increase the risk of needle stick injury (NIOSH, 2010).
At the facility level, supervisory support was found to provide some measure of protection against harassment and all types of violence. Healthcare facilities can devise a system of flagging a patient’s chart if the person has previously been violent during healthcare interaction in order to alert staff members to the potential threat (Phillips, 28 April 2016). This can be the same for home healthcare staff. The flagging of a chart can simply be a red paper, a note that gives a warning or anything that could bring attention to the healthcare worker regarding historical behavior of concern regarding the patient.
In order to promote safety and security in the field, it is extremely important for employers to have a comprehensive workplace violence prevention program. Elements of a comprehensive workplace violence prevention program include environmental modifications, work practice changes, implementation of policies and practices, safety training , use of security and law enforcement, management commitment, risk assessment and integration with the security program, and surveillance of violent events (Casteel, Gross, Nocera, and Peek-Asa, 31 Jan 2013).
Home healthcare employers can help prevent and control violence in a patient’s home by establishing violence prevention programs and tracking the programs in reducing work-related assaults. Occupational Safety and Health Administration recommends the following measures be implemented, create a zero tolerance policy for workplace violence, and require employees to report each incident, even if they think it unlikely to happen again or is not serious in nature or outcome. Additionally, developing a written plan for ensuring personal safety, reporting violence, calling the police, and educating workers about the risks of assignments and how to assess the safety of work environment and surroundings is critical. All reports of dangerous work environments and violent assaults should be investigated, and workers should not be knowingly placed in assignments that compromise safety (Morgan, 16 Dec 2015). If the patient and family are identified as high-risk, various procedures would automatically be followed, such as consulting with supervisors prior to making a visit, arranging for another person to be present, or asking the client to agree to a “no-harm contract”(ACH Media, 01 Mar 1998). In addition, when a patient is recognized as a risk to the healthcare worker their manager can contact the police in the area to use as an escort service. The police can act as a form of security in high crime areas or when the patient has dangerous family members that could possibly harm the care giver.