Workplace Violence in Home Health

by Kristin Rowan | Jun 20, 2025 | Caregiver Safety, Caring for the Caregiver, Clinical, Home Health, Hospice

by Kristin Rowan, Editor

Workplace Violence and Policy Impact

Study of home health workers

A group of researchers from the University of Cincinnati, Ohio published a recent study¹ on the frequency and reporting procedures of workplace violence (WPV) in home healthcare. The study specifically addressed WPV in home healthcare, stating limited understanding of WPV in the home care setting. Most existing studies on WPV were hospital-based.

Frequency of Workplace Violence

Of the home health care workers (HHCW) surveyed, almost 37% responded that they experience both verbal and emotional violence in the workplace daily. More than 80% reported experiencing verbal aggression at some point. Physical violence is less prominent. 20% of respondants said they experience physical violence monthly. However, 56.6% said they have experienced physical violence at some point in their current agency. 76.6% of the time, the perpetrators of the violence are the patients of the HHCW.

Fig. 1 Frequency of occurrence of physical, verbal, emotional, and sexual abuse as a function of time: daily, weekly, monthly, <yearly, yearly, and never.

Reporting Workplace Violence

All of the study participants indicated they had knowledge of workplace violence reporting procedures in their agencies, but 26.7% were unsure if the policies are contained in the employee handbook. 46.7% were uncertain as to whether the agency offered WPV or de-escalation training and 66% said prevention and de-escalation training was not mandatory. Unfortunately, 40% said their management did not encourage reporting and 33% said they were not comfortable approaching management about WPV. Despite the frequency of WPV among the respondents, none of the participants reported these incidents to management.

Thoughts

According to this, and other research studies on workplace violence in home healthcare, the problem is prevalent and persistent. Most HHCWs have experienced some sort of aggression, violence, or abuse in the course of performing their jobs. Of those who have, most do not report the incidents to management. Most HHCWs have not been trained in prevention or de-escalation. Even with training, HHCWs need a way to get immediate help. Unfortunately, most do not have an emergency alert system on their person during home visits.

Solution

Care at Home agencies, including non-medical supportive care, home health, hospice, and any other lone workers who are visiting patients in their homes, need safety policies and procedures. Agencies must include the same in the employee handbook, explain during orientation, and make available to HHCWs digitally.

Policies and procedures should include:

A safety committee comprised of management, back office staff, and field workers
A clearly written policy regarding physical, emotional, verbal, and sexual abuse
- Against a patient or their family/friends by a HHCW
- Against a HHCW by a patient or their family/friends
- Against a HHCW by a colleague or manager
- Against a HHCW by the environment in which they work (i.e. aggressive pets, weapons, cigarette smoking indoors, etc.)
A digital reporting system that employees can use without having to approach management individually
A clearly written policy on the management response to violence reporting
A clearly written policy forbidding any retaliation or discrimination against a reporting employee
Required research about new patients including
- Background/History of violence and/or mental instability
- Neighborhood safety rating
- Family members likely to be in the home and their history of violence and/or mental instability

Additional Tools for HHCWs

Workplace violence against HHCWs is not “if,” but “when.” It is the responsibility of the agencies to lower the risk, lower the percentage of “whens,” and encourage reporting. If you’re not sure how to begin, hire a consultant to help you build your safety committee and write your policies. It doesn’t matter how you start implementing safety protocols, as long as you follow through and protect your employees.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

1. Obariase, E.; Bellacov, R.; Gillespie, G.; Davis, K. (2025). Assessing Workplace Violence and Policy Impact: A Cross-sectional Study of Home Healthcare Workers. Home Healthcare Now, 43(3), 150-156. doi: 10.1097/NHH.0000000000001345

Urgent Plea to Safeguard Your Caregivers

by Kristin Rowan | Feb 6, 2025 | Admin, Caring for the Caregiver, Clinical

by Kristin Rowan, Editor

Care at Home Worker Safety is not Optional!

I will rarely present an editorial piece that is based only on my opinions. I hold a few about care at home in general, but at least attempt to use statistics, facts, and history to support my positions. This is one area where the facts and numbers are all there, but using them is not as effective as sharing these stories. No matter where your agency is in its growth, no matter how large or small, no matter your plans for 2025, if you have not started a safety committee, created safety protocols and operating procedures, and invested in GPS-enabled emergency response systems for your staff, do so NOW, so this story doesn’t become your story.

One More Story is One Too Many

The tragic death of Joyce Grayson made headlines across the country both immediately after her death and for months after with lawsuits and new regulations in her state. This week, another avoidable incident left a home health aide in Massachusetts bedridden and temporarily unable to walk.

The aide, who asked to remain anonymous said she thought she was going to die. “I was screaming Help! Help!,” while a man in his 70s, for whom she has provided care for more than two years, attacked her with a knife. The man repeatedly stabbed, slashed, and sliced her while she kept kicking at him and thrashing her body. Despite all her attempts to escape, the man would not let her get up.

“I was tired,” she recalled, after fending off her attacker, “I’m gonna die here, I think that, but in that moment I remembered my sons, my family and giving me power. I confronted him.”

As she fled the apartment, the man followed her with a piece of wood. She ran down the hallway, where a security guard intervened. The man lost his balance during the struggle and fell. The home health aide spend two days in the hospital, receiving blood transfusions and dozens of stitches. She has decided no to return to her job, which she has held for a decade.

“He’s not going to kill me. He’s not going to pull me down.”

Home Health Aide Attacked on the Job

Next Time, it Could be You

No care at home worker deserves to feel unsafe or to be attacked at work. No agency owner wants to be the headline of the next story about a home care worker who ended up in the hospital or the morgue. Don’t be the next agency that has to explain to a family how this happened to their mother, daughter, son, or uncle, or cousin. No child wants to find out that their parent isn’t coming home because they did not have the means to call for help.

Act Now, Before it's Too Late

You might be surprised, if you asked, how many of your caregivers have ever felt uneasy, unsafe, or uncomfortable during their shift. Whether is the client, a family member of the client, pets, firearms, the neighborhood, or something else, most lone workers will experience some degree of fear. While not entirely preventable, there are steps you can take to minimize the risk:

- Ask your employees for honest feedback
- Research the client, family members, and the neighborhood for safety issues
- Create a committee comprising management, administrators, and caregivers, to create a safety plan
- Invest in training for your staff to include deescalation techniques, situational awareness, self-defense, and any other classes your safety committee deams necessary
- INVEST IN GPS-ENABLED EMERGENCY RESPONSE SYSTEMS FOR EVERY EMPLOYEE, NOW!

Recommendations

As a company that engages in software adoption consulting, we don’t often make direct recommendations, prefering instead to tailor software selection to each agency and its unique needs. This is one area where I will make the exception and continue to make the exception until every lone worker in and out of the care at home industry is equipped with a safety device.

POM Safe

POM Safe is a personal safety solution that allows lone workers to get help when needed, but was designed to incorporate prevention and de-escalation. “The best 911 call is the one that never happens.”

The device includes features such as:

- Fake phone calls to allow the caregiver to step away from a situation
- Check on me to alert the agency if the caregiver has not checked in after an appointment
- Appointment Sync to give first responders precise locations in an emergency
- One-tap text sending a pre-written text with precise GPS location
- Incident Reports to prevent future incidents
- Two-way calling to a dispatcher when emergency help is needed
- Voice activation when your caregiver can’t get to the device
- Real-time crime data by neighborhood
- Sex offender registries
- 24/7 emergency dispatch
- Device or app-based

Katana Safety

The Katana safety device attaches directly to the caregiver’s phone. It has a quick-trigger activation to bypass the phone’s lock screen, and provides instant help 24/7.

This device includes features such as:

- Audible and inaudible alerts that launch GPS signals and connect worker to call center
- 24/7 highly trained PERS center
- Safety text and call after an alert with immediate dispatch if caregiver does not answer
- Walk with me feature to have a dispatcher stay in contact while the caregiver gets to safety
- Circle of safety to alert up to seven people in case of emergency
- Customizable safety commands that each clinician sets up with voice activation
- Beacon backup if bluetooth fails
- Text messaging with GPS location
- Employee check-in with voluntary location tracking and pin drop
- 2-year battery life
- Options to connect by app, fob, watch, or voice

Final Thoughts

Ensuring the safety of your employees before you send them out to care for your clients is not an optional benefit, a “nice to have,” or something you can do when you “get around to it.” Providing the training and safety devices needed to make sure each and every one of your caregivers makes it home every day should be your top priority. Whether you choose one of the devices above or go with a different option, start looking for one now. If you need help starting your safety committee or writing a survey to assess the safety risks in your agency, I will help you. With all of the technology available to us, there should no longer be any stories of caregivers who were attacked and did not have the means to call for help.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

Safeguarding Home Care Heroes Part 2

by Rowan Report | Nov 8, 2024 | Clinical

by Marcylle Combs, BS, MS, RN, CHCE

This article is part 2 of 2-part series. Read part 1 here.

Protecting our Care at Home Heroes

Preventive Measures and Safety Protocols

To deal with these dangers, several preventive steps have been recommended.

Personal Protection

Personal Protective Equipment (PPE) and hand hygiene are basic but important ways to prevent disease spread. Making sure workers are up to date on vaccinations, following cleaning protocols, and safely handling sharp objects and hazardous materials can also significantly reduce risks.

Beyond PPE

Safety policies personal protective equipment

But safety isn’t just about using PPE. There’s also a need for ergonomic tools to prevent injuries, regular safety checks of patient homes, and ensuring safe driving practices for workers who spend a lot of time on the road. Just as important are communication and conflict de-escalation strategies to help healthcare workers manage tense situations with patients or their families.

Training

Training home health workers to spot signs of potential violence or aggression, whether from patients or their families, is vital. They should also have strategies to defuse conflicts and a clear plan to exit safely if a situation turns dangerous. Since hazardous chemicals in the home can be a real threat, agencies should train workers to recognize unsafe conditions and take the necessary steps, like reporting the problem or moving the patient to a safer environment.

Emotional Resilience

A Must-Have for Care at Home Workers

Physical safety is important, but emotional well-being is just as crucial. Feeling emotionally secure—valued, supported, and heard at work—is key to keeping employees engaged and satisfied with their jobs. It helps reduce burnout, absenteeism, and turnover.

Creating a culture of psychological safety starts with good leadership. Managers need to actively listen to their employees’ concerns and encourage open communication. When workers feel that their voices are heard and their opinions matter, they’re more likely to stay proactive and engaged.

Real-Life Examples and the Importance of Strong Policies

The dangers faced by home health workers aren’t just theoretical—they’re very real. I’ve seen this firsthand. As both an owner, administrator, and nurse, there were times we felt unsafe.

One instance that sticks out happened a few years ago

A nurse on a routine visit encountered the patient’s grandson breaking into the house, clearly high on some kind of drug. She and the patient managed to block the bedroom door while she called 911, and thankfully, the police arrived before the grandson could get to them. He was carrying a gun, though she didn’t know that at the time.

Putting Comprehensive Policies in Place

A solid safety program that meets the unique needs of home health workers is a must. This includes having zero-tolerance policies for workplace violence, infection control measures, and clear guidelines for handling dangerous materials. Ongoing education and training are essential to make sure staff follow these protocols.

In addition, there should be regular assessments to gauge how effective safety policies are. Gathering feedback from workers on the ground is crucial to making sure these policies address real-world challenges.

Final Thoughts: Safety is a Mindset

Workplace safety isn’t just about following rules or checking boxes. It’s something that should be part of the culture of every organization. By putting in place measures that protect both the physical and emotional well-being of home health workers, we can ensure that these “home care heroes” continue to provide the critical care that so many people rely on. As Eleanor Everet wisely said, “Safety is not a gadget, but a state of mind.”

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Marcylle has faithfully served and advocated on behalf of home health and hospice patients for over 30 years. She started her career as a nurse, worked diligently to strengthen her leadership skills and ultimately became the owner/president of a successful home health and hospice company. She has served the home care industry in Texas and nationally throughout her years on multiple committees, boards, associations and dedicated lobbying efforts. Currently, Marcylle serves on the board of directors for The National Association for Home Care & Hospice (NAHC), the Home Care and Hospice Financial Managers Association (HHFMA) and the Industry Advisory Board. Additionally, she serves on NAHC’s Governance and Nominating Committee, the HHFMA workgroup, Innovations Committee and chairs the Women in Leadership Committee for HHFMA.

As a wife, mother of 5 adult children and as a female in the workplace she aspires to grow and lead others until her last breath on this earth. She continues this quest through three new business ventures she has founded: MAC Legacy, MAC Legacy Investments and The Marcylle Combs Company.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Preventing Violence: More Action Items

by Elizabeth E. Hogue, Esq. | Jun 20, 2024 | Admin, Caring for the Caregiver, Clinical, CMS

By Elizabeth E. Hogue, Esq.

Violence in Healthcare

According to a recent analysis of Bureau of Labor Statistics data, healthcare is one of the most dangerous places to work. Homecare field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies, and home medical equipment (HME) companies may be especially vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.

Preventing Violence Bureau of Statistics Graph

Must-Haves

First, regardless of practice setting, management should develop a written policy of zero tolerance for all incidents of violence, regardless of source. The policy should include animals. The policy must require employees and contractors to report and document all incidents of threatened or actual violence, no matter how minor. Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include zero tolerance for visible weapons. Caregivers must be required to report the presence of visible weapons.

Below are some additional important actions for healthcare organizations to take that are based on UCHealth’s SAFE Program:

Encourage staff members to STOP if they feel unsafe for any reason.
Workers should pause to generally ASSESS their environments. Staff members should think about what has happened and observe what is currently occurring. Is there, for example, mounting frustration or anger?
Staff should then FAMILIARIZE themselves with the room. Who is the patient? Where is the patient? Are there any factors that might escalate behaviors? Staff members should also consider putting themselves in positions where they have a route to escape, if necessary.
Practitioners should also ENLIST help. Getting help may, for example, include pushing panic buttons on mobile devices.

Here is what Chris Powell, Chief of Security at UCHealth said in Becker’s Hospital Review on June 4, 2024:

“You can’t just talk about the shrimp and give you a good picture. We have to talk about the roux and the rice and everything else that goes into this for a good picture to be painted so people have an understanding. We want to solve this with an electronic learning or a 15-minute huddle, but we can’t. This is continuous and a persistent pursuit toward educating, communicating, recognizing, responding to, reporting and recovering from workplace violence.”

Every caregiver matters. The healthcare industry has lost caregivers to violence on the job in the past. Let’s not repeat these terrible events.