Ensuring the safety of caregivers in home health care is a critical concern for agency leaders. Recently, Home Health Revealed hosts Michael Greenlee and Hannah Vale had the opportunity to discuss this pressing issue with Robert W. Markette, Jr., CHC, HCS-C, an attorney and renowned speaker on workplace safety in home care settings. Listen to the full episode here: https://healthrevpartners.com/podcast/ensuring-safety-in-home-care-addressing-violence-and-risk-for-caregivers/ . Our conversation shed light on the multifaceted challenges faced by home care workers and provided valuable insights into strategies for mitigating risks.
The Alarming Reality of Home Care Safety
To set the stage for our discussion, Bob highlighted some sobering statistics from a study conducted by the National Institute of Occupational Safety and Health. Between 2015 and 2020, approximately 117,000 home care workers sought treatment for work-related injuries in emergency departments. Strikingly, 93% of these workers were female, underscoring the gender disparity in our industry.
What truly caught our attention was that 15% of these injuries were attributed to violence from persons or animals. While violence isn’t the predominant risk our staff face, it’s a reality we cannot ignore.
Understanding the Unique Challenges of Home Care
As we delved deeper into the conversation, Bob emphasized the unique position home care staff find themselves in when entering a client’s home. Unlike controlled environments such as hospitals or care facilities, home care workers often step into unfamiliar settings with limited prior information.
“We don’t know where we’re going into these homes,” Bob explained. “We go in, we have very little information other than what’s in the medical record.”
This uncertainty is compounded by the fact that we have limited control over the home environment. We can’t implement standardized safety measures across all client homes, making each visit potentially unpredictable.
The Double-Edged Sword of Familiarity
Interestingly, Bob pointed out that the generally safe nature of home care can lead to a dangerous complacency among our staff. The fact that most interactions are positive and without incident can cause caregivers to let their guard down.
“999 times out of a thousand, nothing bad happens when they go in to work,” Bob noted. “Everyone loves their home health worker. For some of our patients, that may be their primary interaction with human beings in any week.”
While this familiarity is often a positive aspect of home care, fostering trust and rapport between caregivers and clients, it can also lead to a false sense of security. As leaders, we need to find ways to maintain our staff’s vigilance without creating unnecessary fear or anxiety.
Beyond the Front Door: Environmental Risks
One crucial point Bob raised is that the risks our staff face aren’t limited to interactions with clients. The neighborhoods and external environments where our caregivers work can pose significant dangers.
Bob shared a heartbreaking story of a home care worker who was tragically killed, not by a client, but during a mugging as she approached a client’s home. This serves as a stark reminder that our safety considerations must extend beyond the confines of our clients’ residences.
Practical Strategies for Enhancing Safety in the Home Health Environment
So, what can we, as home care leaders, do to protect our staff? Bob offered several practical suggestions:
1. Comprehensive Training
Bob emphasized the importance of thorough training that goes beyond clinical skills. This should include:
- Situational awareness: Teaching staff to be conscious of their surroundings and potential risks.
- De-escalation techniques: Equipping caregivers with the skills to defuse potentially volatile situations.
- Exit strategies: Encouraging staff to always be aware of escape routes and to position themselves near exits.
“It’s about being conscious about what’s going on around you and being proactive to think about those things,” Bob advised.
2. Improved Intake Procedures
Bob suggested enhancing our intake processes to identify potential red flags:
- Look for indicators of mental health issues or aggressive behaviors in client histories.
- Review notes from previous care facilities for any mentions of challenging behaviors.
- Assess neighborhood safety and potential external risks.
“When we’re doing intake, we’re thinking about what’s in the file that goes to PDGM and coding and that kind of stuff. But we’re not looking for red flags about things that might indicate a risk to our staff,” Bob pointed out.
3. Fostering Open Communication
Create an environment where staff feel comfortable reporting concerns or incidents. Regular check-ins and debriefings can help identify potential issues before they escalate.
4. Leveraging Technology
While not a cure-all, Bob acknowledged that technological solutions like emergency alert systems can play a role in enhancing safety. However, he cautioned that these systems have limitations, particularly in rural areas with poor cellular coverage.
“There are now technological solutions for stuff like that. There are companies that are coming onto the scene where they have badges that will signal a security team who will call 911,” Bob explained. However, he added a crucial caveat: “If I’m with a patient out in the country, and I’m miles and miles away from the police when I hit that button, I’m still on my own for 10, 15, 20 minutes.”
The Weapons Debate: A Word of Caution
During our conversation, we raised the question of equipping staff with self-defense tools like tasers or pepper spray. Bob’s response was measured but clear: proceed with extreme caution.
“I would be very hesitant to do that,” Bob advised. He outlined several concerns:
- Legal implications: The potential for lawsuits if such devices are misused.
- Training requirements: Ensuring staff are properly trained in the use of these devices is a significant undertaking.
- Ethical considerations: The optics of caregivers using weapons against clients, particularly those with conditions like Alzheimer’s, could be devastating.
“If you think about it, we see cases with the police, right? They’re getting sued over tasering and things like that. So did we go through all the right training? Was a taser used properly? Did my employee overreact to a situation? And do we have an Alzheimer’s patient who was acting out because of their disease process, get tasered by a skittish employee?” Bob questioned.
Instead of arming our staff, Bob suggested focusing on de-escalation techniques and situational awareness. These skills are not only more practical but also align better with the caregiving nature of our work.
The Importance of Preparation
Throughout our discussion, Bob repeatedly emphasized the importance of preparation. This includes:
- Conducting thorough risk assessments for each client and their environment.
- Developing clear protocols for various emergency scenarios.
- Regularly reviewing and updating safety procedures.
- Providing ongoing safety training and refresher courses for all staff.
As leaders, it’s our responsibility to ensure our staff are as prepared as possible for any situation they might encounter.
Legal Considerations
Given Bob’s legal background, we asked about the potential liabilities agencies face regarding staff safety. He stressed the importance of having clear, well-documented safety policies and procedures. If you’re considering implementing any new safety measures, particularly anything involving self-defense tools, Bob strongly recommends consulting with an attorney to understand the full legal implications.
“If an agency was thinking about giving their staff pepper spray or tasers, my primary takeaway from that would be talk to an attorney, get a very clear opinion in writing, and then whatever they tell you to do, because there’s going to be all sorts of issues and controls there. You’ve got to follow all of it,” Bob advised. “Because when something like that were to be used by your staff, you’re going to get sued. And if you don’t have all the I’s dotted and the T’s crossed, you’re likely going to end up owing somebody a lot of money.”
A Balanced Approach
As we wrapped up our conversation, Bob emphasized the need for a balanced approach to safety in home care. While we must take the risks seriously and implement robust safety measures, we also need to avoid creating an atmosphere of fear that could negatively impact the quality of care we provide.
“Most of the time, I try not to be the guy that’s terrifying everybody,” Bob said. “It’s about being conscious about what’s going on around you and being proactive to think about those things.”
Conclusion: Our Responsibility as Leaders
As leaders in the home care industry, ensuring the safety of our staff is one of our most critical responsibilities. The insights shared by Robert Markette serve as a valuable guide in navigating this complex issue.
We must strive to create a culture of safety within our organizations, one that balances awareness and preparedness with the compassion and dedication that defines our industry. This involves ongoing training, open communication, thoughtful risk assessment, and a commitment to continually improving our safety protocols.
Remember, our caregivers are on the front lines every day, providing essential services to those in need. By prioritizing their safety, we not only protect our staff but also ensure the continuity and quality of care for our clients.
Key takeaways from our discussion with Bob include:
- Recognize the unique risks associated with home care work.
- Implement comprehensive training programs that focus on situational awareness and de-escalation techniques.
- Enhance intake procedures to identify potential risks before staff enter a client’s home.
- Consider technological solutions, but be aware of their limitations.
- Exercise extreme caution when considering equipping staff with self-defense tools.
- Consult with legal experts before implementing any new safety measures.
- Foster a culture of open communication about safety concerns.
- Regularly review and update safety protocols.
- Balance safety measures with the need to provide compassionate care.
As we move forward, let’s take these insights to heart and work together to make home care safer for everyone involved. After all, when our caregivers feel safe and supported, they’re better equipped to provide the exceptional care our clients deserve.
By implementing these strategies and maintaining a vigilant yet balanced approach to safety, we can create a more secure environment for our staff while continuing to deliver the high-quality care that defines our industry. Let’s commit to making safety a top priority in our agencies, ensuring that our caregivers can focus on what they do best – providing compassionate care to those who need it most.
