'Most organizations focus on protecting the patient and less on protecting the home care worker,' a Johns Hopkins professor says.
Private duty and home health administrators must tackle many industry challenges as leaders, such as worker shortages and reimbursement issues. Another of those challenges is workplace safety and how to keep in-home care workers safe from abuse and bodily harm when taking care of clients.
Nancy Glass, PhD, MPH, MS, RN, began examining workplace safety for in-home care workers during a study in 2010. She says, “Most organizations focus on protecting the patient and less on protecting the home care worker." Listening to workers, primarily women, tell their stories, she found that many were afraid to report instances where they'd been harassed, threatened, or physically hurt by patients or other individuals in the home.
"They had very little support and resources and felt like in some cases they couldn't report it; that they would lose their jobs," Glass told HealthLeaders.
A professor at Johns Hopkins School of Nursing and associate director of the university's Center for Global Health, Glass has a background in prevention of violence against women and children.
The home care workers she spoke with for the study said they felt vulnerable in the workplace, concerned about being believed after abuse had occurred, and unable to quit because they needed the health benefits. There were also concerns about false accusations against them, which could affect their ability to get work in the future.
"They're walking into a home where there's a lot of complex issues, and they really want to support the patient, but there's conflict in the household that they're witnessing, safety issues. Sometimes it's directed at them when they're there," Glass explained.
"They do believe in the importance of their work and the passion of their work, so it is very hard for them to walk away from a situation when they know it's bad."
So, what can in-home administrators do to ensure safety for their workforce?
As for interventions and methods of supporting in-home care workers, while Glass acknowledges agencies and providers can't afford to send workers in pairs, they can encourage their employees to develop their own support system. Maintaining that network and mentoring new workers is one way to combat the isolation that many can feel while on the job.
Glass also suggests teaching workers to set and maintain boundaries to prevent conflicts with clients and their families.
"It's really about safety planning, being confident when setting boundaries on what you will and will not do," she said. "A lot of times when there was a home care worker in the home and other family members were living there, their role would bleed into taking care of everyone."
Workers should also have a fundamental knowledge of self-defense, so if they find themselves in an unsafe situation, they're able to get out of it. It's important, Glass noted, that agencies or providers have a safety plan in place for their workers and that they know what to do in an emergency for themselves and their clients.
"An ideal situation would be [providers and agencies] investing in more training and working with patients and family members about expectations and their behavior," Glass said. "[That way] it's not all on the home care worker to manage the situation."
“They do believe in the importance of their work and the passion of their work, so it is very hard for them to walk away from a situation when they know it's bad.”
Nancy Glass, PhD, MPH, MS, RN, professor, Johns Hopkins School of Nursing
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
While working on a study in 2010, Glass found that female in-home care workers were afraid to report instances of abuse or mistreatment due to lack of support or fear of losing their jobs.
Setting and affirming boundaries for the client and their family, and developing safety plans for emergencies can help workers stay in control and out of danger.