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Analyzing Home Healthcare: Why is Workplace Violence a Concern?

Posted by Tina Servis January 17, 2023

Home healthcare workers are at a greater risk of experiencing workplace violence than those in most other sectors, from the underlying causes behind the heightened aggression to steps that home healthcare companies can take, discover what you need to know to protect your team and create a safer work environment. 

What do home healthcare workers do?

Home healthcare is a vital service that provides necessary healthcare to individuals in their homes. Home health workers, such as personal care aides, home health aides, nursing assistants, and others, provide help with activities of daily living like bathing, dressing, and feeding. In addition, they can also provide skilled medical services, including administering medication. As with many jobs, home healthcare workers are at risk of workplace violence. This is a critical issue to consider, and proper training and licensing will be necessary to ensure the safety of the home healthcare worker.

The home healthcare workforce – is growing and diverse.

Home health and personal care aides are some of the fastest-growing occupations, with an estimated 3.5 million working in 2019 and an additional 1.1 million jobs projected by 2029 (BLS Occupational Outlook Handbook). With the growth of home health care services, home healthcare workers face increased risks of workplace violence and other safety concerns. In 2021, 74,000 employees were employed with American Staffing Association (ASA) affiliated home care agencies (5). The likely cause for this surge is related to a preference by patients to remain at home, the growing prevalence of chronic illnesses, the aging population, and advances in medical technology, which enable healthcare services to be provided in patients’ homes.

Home healthcare workers, predominantly female, non-white, and generally having low incomes, are particularly prone to workplace violence. In 2020, 88% of workers in the home healthcare services industry were female, 29% were Black or African American, and 19% were Latino or Hispanic (BLS Current Population Survey). The median annual pay for home health and personal care aides was just $27,080 that year ($13.02 hourly) (BLS Occupational Outlook Handbook). Additionally, many home healthcare arrangements provide minimal minimum wage or overtime pay protections and can create job insecurity for those working under such conditions. This can lead to added fear of speaking up about risks associated with violent threats in home health care environments.

Workplace violence definition and typology

Workplace violence is defined as the “act or threat of violence ranging from verbal abuse to physical assaults directed toward persons at work or on duty.” Workplace violence is work-related aggression or challenge to workers’ safety, health, or well-being from intimidation, abuse, or attack. The World Health Organization categorized workplace violence as physical, psychological (emotional), sexual, and racial. Workplace violence includes incivility, bullying, verbal abuse, physical assault, and sexual harassment.

The workplace violence typology was developed to classify the relationships between the victim and the perpetrator. A summary of the four types of workplace violence is as follows:

  1. Type I, criminal intent, an employee is robbed, or their property is vandalized.
  2. Type II, a patient/client or family member attacks an employee.
  3. Type III, a co-worker threatens or attacks another co-worker.
  4. Type IV personal relationship, when someone known to the employee outside of work, such as a significant other, threatens or attacks the employee while at work.

Understanding the Causes of Workplace Violence in Home Healthcare

These workers’ difficult circumstances often cause workplace violence in home healthcare. Limited resources, inaccurate or delayed billing, and unpredictable client behaviors can all contribute to an increased risk of violence against healthcare workers. Providing training and support to empower caregivers with the necessary tools to handle complex scenarios is integral to reducing workplace violence in home healthcare.

Numerous and interrelated risks for workplace violence

Scientific studies have linked violence in home healthcare settings to adverse emotional, cognitive, behavioral, physical, and psychosocial outcomes among workers. The negative effects of violence can severely impact the delivery of healthcare services and the quality of care and can result in diminished productivity, job dissatisfaction, drug and alcohol use, and poor health outcomes among workers. Studies have presented several consequences of workplace violence in healthcare, including worker burnout, reduced quality of life, and mental health problems (such as emotional exhaustion, suicidal thoughts, depression, and anxiety). Home healthcare workers’ job characteristics and requirements place them at high risk for workplace violence, particularly Type I and Type II. Home healthcare workers primarily work alone in situations that can be dangerous. In addition to workplace violence, they often face similar occupational hazards as other healthcare workers employed in hospital settings, along with risks specific to the home care environment, such as unpredictability and decreased control of their work environment, lack of policies and procedures, and insufficient training.

Strategies to Mitigate Workplace Violence When Providing Home Care Services

As a home health care provider, it’s essential to recognize the signs and symptoms of potential workplace violence and implement strategies for prevention. These can include implementing comprehensive safety policies, conducting regular training sessions for employees on de-escalation techniques, and providing support services for victims of aggression. Additional steps to mitigate the risk include:

  • Developing a clear reporting structure for incidents.
  • Establishing clear boundaries between caregivers and clients.
  • Providing access to security personnel if necessary.
  • Assessing client behavior before beginning care.

Preventing workplace violence to home healthcare workers

Different strategies can be used to protect home healthcare workers from violence. The issue is currently receiving attention in Congress. Workplace violence in the home healthcare environment is complex and requires multi-faceted prevention efforts. One way to approach this is to apply Haddon’s Matrix to workplace violence in home healthcare (Table 1, adapted from McPhaul and Lipscomb [29]). The Haddon Matrix uses traditional public health terms such as ‘host’ and ‘agent/vehicle’ and applies them to the victim (in this case, the home healthcare worker) and the combination of the perpetrator (whose identity varies per the workplace violence type described above), their weapon, and the force of the assault, respectively.

Employers should adopt evidence-based prevention measures to prevent workplace violence among their home healthcare workers.

The following are examples of crucial prevention measures:

Provide standardized protocols that include:

  • A zero-tolerance policy toward workplace violence
  • Policies and rules on the safety of lone home healthcare workers in the field, such as regular cell phone contact or check-ins and conducting home visits in pairs and with security escorts
  • Rules and strategies related to visits in homes or neighborhoods where violence has occurred in the past
  • Management commitment to home healthcare worker safety, including the formation and support of safety committees that involve field home healthcare worker participation and input

Provide comprehensive training to home healthcare workers on workplace violence that includes:

  • Acquiring content specific to home healthcare workers and their work environment
  • Assessing the work environment and surroundings for safety, including the presence of drugs of abuse, drug paraphernalia, weapons, and aggressive pets
  • Recognizing signs of imminent violence, including verbal abuse and aggressive body language or posturing
  • Employing verbal de-escalation techniques
  • Utilizing escape and egress techniques
  • Recognizing and reporting intimate partner violence and child abuse/neglect

Conduct post-visit assessments, recordkeeping, and evaluation

  • Assess completed visits for violent events that occurred or were imminent (e.g., near misses)
  • Identify factors that contributed to a violent event and/or hazardous environment.
  • Identify strategies and resources to prevent future occurrences.
  • Record events and monitor records for trends in workplace violence and the effectiveness of workplace violence prevention policies and practices

Post-incident support and reporting systems

Post-incident support services can have great value for home healthcare workers’ well-being. Services might include peer support, formal debriefing, trauma-crisis counseling, and employee assistance programs. Reporting workplace violence is very important to understanding the magnitude of workplace violence in the home healthcare industry and providing data to inform future workplace violence prevention strategies. Research into how to increase the participation of home healthcare workers in post-incident debriefing is necessary to help prevent future workplace violence and improve worker health.


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