Education Key to Protecting Hospice Staff from Workplace Violence

Ensuring staff are educated and trained is crucial for hospices to minimize workplace safety risks, particularly when it comes to providing community-based care.

Safety is an ever present concern for hospice providers in any setting, but the home may be the toughest for employers to help staff navigate.

Keeping hospice and home health staff safe while working out in the community is a multifaceted challenge, according to Eugenia Smither, vice president of compliance and quality improvement at Bluegrass Care Navigators.

Compared to facility-based staff, these home-based care providers face unique circumstances and environmental factors that are often beyond their control and can pose safety risks, Smither said during the recent National Hospice and Palliative Care Organization (NHPCO) Interdisciplinary Conference.

“The threat is greater in the home than in the hospital or a facility,” Smithers said. “When you’re within the confines of a facility, you have some protections, additional staff members, security staff, and rules that are clearly posted. Often, home care workers are solo practitioners and by themselves. To a certain extent, we need to follow the rules in the home, even if they conflict with what our own rules and what society’s rules may be. The lines can become blurry, because each home has its own rules.”

The National Institute of Occupational Safety and Health (NIOSH) defines workplace violence as an act or threat of violence that can include physical assault or verbal abuse directed towards an individual at work or “on duty.” This also includes psychological abuse, harassment, intimidation, and other threatening and disruptive behaviors that occur at the worksite.

Risks for workplace violence and other safety concerns for home-based care workers are expected to increase alongside demand for those services, according to a 2021 analysis from the Centers for Disease Control and Prevention (CDC).

Research has shown that 18% to 65% of home health care workers experienced verbal abuse from patients during the past two decades, the CDC indicated in the report. Roughly 41% reported being sexually harassed in the workplace, and as many as 44% experienced a physical assault during that time.

Safety concerns among community-based home health and hospice workers may be on the rise.

An unidentified hospice nurse and her patient were recently robbed at gunpoint in Chesterfield County, Virginia. The hospice worker alleged that a man wearing a white medical mask grabbed her by the neck in a chokehold and pointed a gun at her ribcage. He then forced the two inside the patient’s home, where he took roughly $2.00 and left. The patient was unharmed and the hospice worker sustained bruising around her neck.

The key to preventing violence in community settings is to ensure hospice staff are prepared, educated and trained in how to both identify and handle risky situations, the hospice worker told local news.

“We feel safe leaving the elderly’s home, because we believe that the elderly are safe. No one wants to hurt them,” she told local news. “We both survived it unharmed. That’s the positive thing. But health care workers need to be aware of their surroundings more, and be prepared.”

This also applies to educating family members and caregivers about best safety practices. Following the incident, family members put a camera up outside of the patient’s home. The suspect could face criminal charges for the alleged assault.

Home health care clinicians and social service workers face an increased risk of work-related assaults that can result primarily from violent behavior of their patients, or community residents, according to the U.S. Occupational Safety and Health Administration’s (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers.

Workplace prevention programs should be incorporated in a health care organization’s overall safety and health policies, and staff education models, according to the OSHA Guidelines. The building blocks for developing an effective workplace violence prevention program include management commitment, employee participation, worksite analysis, recordkeeping, safety and health training, the guidelines stipulate.

Staff may not be able to adequately identify when they are in or approaching a potentially threatening situation, as these can be more difficult to ascertain in a patient’s home, according to Smithers.

Awareness is important for home health and hospice workers to bear in mind, she said.

An estimated half of home-based care workers experience “some sort of verbal abuse” on the job, while roughly 15% have experienced physical abuse, Smithers indicated. Causes abound for this trend, including trauma for the victim or concern for a patient if they were the assailant. Patients with behavioral health issues such as dementia or serious mental illnesses, for instance, can sometimes unintentionally harm workers, she explained.

“[Workers] don’t always have an awareness that what they’re experiencing could be classified as workplace violence, and they don’t document it outside of the medical record,” she said. “They don’t report it, even though there are policies and protocols in place to do so. Some of them just want to forget about it and not relive the trauma. Most of the documentation, it may occur in the [EMR] record describing the patient’s behavior as part of an assessment, but it doesn’t get documented administratively.”

Legislators have begun looking into the issue as well.

Last week, Sen.Tammy Baldwin (D-Wisc) and Rep. Joe Courtney (D-Conn.) introduced bipartisan, bicameral legislation that would direct OSHA to develop a standard requiring health care and social service employers to write and implement a workplace violence prevention plan to protect their employees.

“Our health care and social service workers deserve to work in a safe environment free from violence,” Baldwin said in a statement. “It is unacceptable that our health care workers are subjected to senseless acts of violence in their workplace, and we must do more to protect them.”