Under any circumstance home care workers are at high risk for workplace violence for the following reasons:

1. prevalence of handguns and other weapons among patients, their families and friends;
2. isolated work environment - field clinicians are typically all alone when visiting patients;
3. home visits are often performed in high crime areas or remote locations with no means of back-up;
4. poorly lit and/or isolated parking areas;
5. public perception that health care workers carry drugs and drug paraphernalia;
6. increasing presence of gangs, drug and alcohol abusers, and presence of dysfunctional family members at home visits;
7. increased service delivery times to include evening and night visits.

Evaluating the Patient & Home for Potential Violence

When the Case Manager performs the admission visit s/he is also determining if it will be safe for clinicians and aides to perform home health services. Signs of an unsafe home environment include:

• presence of weapons
• known psychiatric issues
• hostile animals
• unhygienic and/or dangerous conditions in the home
• physical aggression
• verbal and/or physical abuse between family members

If any of these warning signs are present - or for any reason - the Case Manager would complete the Patient “Aggression Towards Others” Assessment Scale (1). If the patient receives a rating of 0, a caregiver visiting the patient would practice basic safety awareness (see below) and carry basic safety devices. If a patient receives a rating of 1 to 25, an assigned caregiver would practice advanced safety awareness, carry advanced safety awareness devices. For a patient who rated a minimum of 26, a caregiver would practice advanced safety awareness and have an escort present during visits.

For all patients with scores of 1 or greater, the Case Manager would require the patient/POA to sign the Patient No Harm - Safe Environment Contract. The contract is renewed by the Case Manager every time there is a documented incident of violation of the contract.

Regular Evaluation of Neighborhoods for Safety Hazards

The Agency should regularly screen for safety hazards in geographical areas where staff make visits. The Agency should assign a safety rating for each geographical area it serves on a Neighborhood Safety Checklist Form. On a weekly (if in a high crime area) or monthly or annual basis (depending on the regular number of incidences of reported crimes in a given neighborhood), the Scheduling Coordinator contacts the local police department to obtain information regarding the occurrence of reported crimes in the neighborhoods served by the Agency, and documents the essence of the report on a Neighborhood Safety Checklist Form. If a neighborhood has no report of crime activity, it receives a rating of 1. For reports of one or more incidences of any type of crime activity, the neighborhood will receive a rating of 2.

Field Staff Receive Training on Personal Safety During Home Visits

For new staff  - and annually thereafter - your HHA should provide training to direct care staff to include (1) causes of in-home violence, (2) reasons for in-home violence, (3) predictors of in-home violence, (4) appropriate reactions to in-home violence, (5) in-home violence-provoking behavior, and (6) safety awareness.

Basic Safety Awareness

1. Before making home visits, all purses and wallets should be locked in the trunk of the car before entering the patient’s home.
2. Always have detailed directions to get to the patient’s home. The clinician should always know exactly where s/he is going.
3. Alert the patient/family of the time of arrival so that they are watching and waiting for the clinician.
4. At apartment buildings or housing projects, the clinician should check in with the building captain or security clerk wherever possible.
5. If driving alone, drive with windows at “ear-lobe” level and keep all car doors locked. Keep the interior of the care free of personal belongings.
6. If making an evening or night visit, park in a well-lit, easily accessible, and safe area.
7. Always be cognizant of the surrounding area. Do not stop or leave the car if feeling unsafe.
8. The type of nursing bag used should not look like it carries any medical supplies. Keep all medical supplies out of sight.
9. The clinician must carry a hand-held alarm regardless of the patient or neighborhood safety rating.
10. Do not partake in heavy or lengthy conversations with family or neighbors no matter how pleasant the parties seem to be.
11. Never walk through a crowd. Find an alternate source of entry into the building or home.
12. Do not attempt to break up domestic arguments.
13. ALWAYS TRUST YOUR INSTINCTS. Threats to personal safety can happen anytime, anywhere - even if the neighborhood or person’s home does not fit the profile of an unsafe environment.

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